Pain is a frequent problem following recent traumatic spinal cord injury (SCI). Of specific concern in the rehabilitation setting is function-limiting hand pain which prevents optimal participation in therapy and limits independence. A treatable etiology of function-limiting hand pain in SCI is the reflex sympathetic dystrophy syndrome (RSDS). The presentation of RSDS in patients with recent SCI can be easily confused with that of dysesthetic (central origin) or radicular pain. Previous reports of RSDS associated with recent traumatic SCI have not been based on specific clinical criteria outlined in recent literature, and treatment has not been evaluated by objective outcome measures. This report describes 5 cases of RSDS associated with recent traumatic SCI that are identified by specific clinical criteria and are confirmed by a 3 phase bone scan. It is suggested that aggressive early intervention is necessary to obtain optimal functional outcome and minimize length of hospital-based rehabilitation.