Fever in the Hand

A 14-year-old female adolescent was being treated for malnutrition secondary to anorexia nervosa. She complained of severe "shooting" pain, swelling, and color and temperature changes in her left (dominant) hand. She had recently suffered a fall during a hockey game and pounded on the table during a "temper tantrum." On exam, the left hand was cyanotic, edematous, and cold, with severe hyperesthesia. A bone scan showed marked reduction in flow to the left hand. She underwent eight sympathetic ganglion blocks resulting in transitory Horner's syndrome. Favorable plethysmographic changes occurred and her recovery was complete. Her eventual diagnosis was reflex sympathetic dystrophy syndrome.