Thoracic Sympathectomy Flashcards
Indications for throacic dorsal sympathectomy
- Hyperhidrosis
- Complex regional pain syndrome (CRPS)
- Raynaud’s phenomenon
Definition of hyperhidrosis
Excessive sweating that interferes with livelihood or quality of life
Incidence of hyperhidrosis
< 3%
(familial association)
Diagnostic criteria of hyperhidrosis
- Focal sweating > 6 months
- Bilateral, symmetric sweating that impairs QOL
- Occurs at least once a week
- Starts prior to age 25
- Does not occur during sleep
- May be associated with family history
Complex Regional Pain Syndrome (CRPS) includes what two disorders
- Reflex sympathetic dystrophy (RSD, Type I)
- Causalgia (Type II)
Presenting symptoms of CRPS
- Pain
- Hypersensitivity to minimal stimuli
- Burning
- Cutaneous muscular atrophy
- Faigue and weakness
- Vasomotor instability (sweating)
- Patchy bone demineralization
Presenting signs of CRPS
- Edema
- Stiffness
- Discoloration
- Tenderness
- Atrophy
- Decreased motor function from flexion
Pathophysiology and Charcteristics of CRPS Type I
Type I: Reflex Sympathetic Dystrophy
- Occurs after tissue trauma
- Symptoms not confined to specific nerve or dermatomal distribution
Pathophysiology and Characteristics of CRPS Type II
Type II: Causalgia
- Occurs after injury to peripheral nerve
- Symptoms start within territory of injured nerve; may extend outside nerve distribution
Diagnostic modalities used to confirm Complex regional pain syndrome
- Autonomic testing
- Bone scintigrophy (e/o bone demineralization)
- X-ray
- MRI
Presents with numb and cool extremity in response to stress or cool temperatures
Raynaud’s phenomenon
(abnormal vasoconstriction of digital arteries and arterioles)
Classic presentaion of Raynaud’s phenomenon
Sharply demarcated biphasic response (pallor and cyanosis)
Conservative, non-operative management of Hyperhidrosis
- Drysol solution (aluminum chloride hexahydrate)
- Iontophoresis
- introducing ionized substances through skin via electical current)
- performed frequencly (weekly)
- adverse cutaneous symptoms (dryness)
- Botulinum toxin (duration 6-9 months)
- Glycopyrrolate
TOC for patients refractory to conservative management
Thoracic dorsal sympathectomy
Conservative managment of CRPS
- PT/OT
- Smoking cessation
- Medications:
- anticonvulsants
- bisphosphanates
- steroids
- calcitonin
- topical capsaicin
- Steroid injections
- Electrical nerve stimuation
- Regional sympathetic nerve blocks
- Dorsal column spinal cord stimulation