Clinical observation on the use of topical nitroglycerin in the management of severe shoulder-hand syndrome.

: A simple widely endorsed treatment protocol for RSD does not exist in the literature. This lack of established management procedures reflects the multiple and often undetermined predisposing factors and variances in patient presentation. The most important factor in the successful management of RSD is early recognition and treatment. The goal of therapy is to relieve pain, limit swelling, prevent complications and restore function of the involved limb. Medical treatment becomes a more difficult challenge in the late stage. Treatment regimens for stage III RSD have been largely unsuccessful, and their benefits infrequently maintained. We observed increased level of function, as well as subjective improvement of pain and reduction of edema in our patient. Additional evaluation will help define the role of venous dilation as it relates to the efficacy and optimum utility of NTG in the adjunct management of stage III RSD. To further document the clinical efficacy of topical nitroglycerin as an adjunct in the management of stage III RSD, placebo controlled studies are indicated.