Any correlation between Reflex Sympathetic Dystrophy and previous Endoscopic Thoracic Sympathectomy?
The two entities sympathectomy and RSD are totally unrelated. Reflex Sympathetic Dystrophy or RSD has also other names such as chronic regional pain syndrome. In those situations an injury to an extremity which results in chronic pain can cause some typical situations where patients have pain on a very chronic basis on those extremities and associated with it is redness, swelling, burning sensations and a great deal of discomfort. Unfortunately the treatment of those chronic cases is very difficult and as a result the name Reflex Sympathetic Dystrophy was attached to this clinical presentation with the idea behind it that it is caused by reaction of sympathetic fibers to the previously mentioned injury. It has nothing to do with sympathectomy, as a matter of fact this chronic pain situation is treated at times with sympathectomy not for the issue of sweating but instead to treat the pain. Those attempts are usually unsuccessful, especially if those patients were treated for a long time (months and years), by pain management teams with different treatment modalities such as oral medications, injections, regional blocks etc. By the time those patients come for sympathectomy as a possible cure their illness become not a local illness at the extremity but rather a brain mediated problem which is very difficult to eradicate.
This question and answer was inspired by a patient of ours who had sympathectomy many years ago with very good results which included complete dryness of the hands as well as minimal compensatory sweating. The patient was slightly overweight fell and injured her hands and knees and needed chronic pain treatment. A nuclear study done after a while showed radiological findings of Reflex Sympathetic Dystrophy. So in this case those findings were due to the fall and the prolonged treatment and not because of the ETS.