Nails become brittle and cracked. Muscles develop more severe spasms and atrophy. In the third stage changes become irreversible and may even spread. If a hand is involved, the part may be transformed into a claw-like extremity. A common, consistent complaint during all stages is constant, intense, burning, pain.
Severe discomfort causes the patient to possessively guard the affected part and to avoid movement.
RSDS patients often demonstrate profound emotional and behavioral manifestations as a result of dealing with chronic pain. Although some practitioners have alleged that certain personality types are more prone to this kind of pathology, there is little evidence to support this view. Early diagnosis is usually based on the patient's history and clinical presentation. However, an accurate assessment of pain and related sympathetic physiological changes experienced by patients is difficult. Routine lab values in the early stages are normal or only reflect other underlying diseases.