Eighty-five consecutive post-CVA hemiplegic patients were assessed prospectively for radionuclide and clinical features of reflex sympathetic dystrophy (RSD). Scintigraphy, a safe and relatively noninvasive procedure, has proved to be more sensitive than clinical evaluation for early diagnosis of RSD. RSD was found to be more prevalent in the post-CVA hemiplegic patient than previously reported. Twenty-one patients (25%) exhibited radionuclide evidence of RSD based on delayed scan criteria of increased uptake in the hemiplegic wrist, metacarpal-phalangeal (MCP) and interphalangeal (IP) joints. Two patterns of soft tissue blood flow were observed. Eight scan-positive RSD patients presented a low flow pattern identical to the non-RSD hemiplegic patients while the remaining thirteen exhibited a high flow pattern. Neither demographic characteristics, co-morbid conditions, etiology of CVA, nor site of lesion had any bearing on RSD development. There was no clinical or radionuclide evidence of bilateral involvement commonly described in other heterogeneous RSD populations. Clinical diagnosis was difficult, as various features of the syndrome were often present for other reasons and the presentation was frequently incomplete. MCP tenderness to compression proved to be the most valuable clinical sign of RSD, with a predictive value, sensitivity, and specificity rates of 100%, 85.7%, and 100% respectively.