RSD, or reflex sympathetic dystrophy, is a chronic pain disorder involving the sympathetic nervous system. An injury will activate the body's pain recognition. But a disturbance within the normal sympathetic nervous system occurs and an abnormal cycle of extreme pain begins.There are three stages of RSD.
The first stage is prolonged pain more severe than the injury, described as burning. Initially, there is swelling, sensitivity to temperature and light touch. This stage can last one to three months and resolve without treatment.
The second stage includes symptoms of continuous pain; the skin becomes cool and blue with increased stiffness of ligaments and joints. This stage may last an additional three months with a rare chance of improvement.
Finally in Stage 3, the pain may extend beyond the initial injury site. The affected muscles will waste with contraction of tendons and a definite withering of the affected limb will occur.
Severe chronic pain continues to be the major complaint. This stage is irreversible.
- Trauma (often minor) such as a bruise, sprain, or broken bone
- Heart attack
- Carpal tunnel syndrome or repetitive motion disorder
Treatment options can include physical therapy to the affected limb, pain medications, transcutaneous electrical stimulator, and sympathetic nerve blocks. If conservative therapy does not work but the nerve blocks relieve pain even for a short period, then surgical sympathectomy can be considered.
The videoscope surgical procedure performed to treat RSD is called thoracoscopic sympathectomy. The procedure is performed using a thoracoscope -- a tiny camera that transmits images from inside the chest to a video monitor. The video camera and instruments are inserted through two to three small incisions located in the side of the chest under the axilla (armpit). The sympathetic chain is located and the thoracic segment of T2-T4 is cut or clipped. The incisions are sutured internally so that no sutures will need to be removed following the procedure.
Some individuals want to go home the same day as surgery, and some spend the night and go home the next morning. Patients are able to return to most normal activity within four to five days after surgery. The only limitation is on heavy lifting for a week or two after surgery, which could cause pain. Patients are usually able to return to work within two to five days. Patients are sent home with pain medication that will be needed for a few days after surgery. Patients are able to shower two days after surgery.
There is an 80 to 90 percent success rate with this surgery if performed in the early stages of progression of the RSD.
No surgery is without risk, but complications from this procedure are very rare. Bleeding, pneumothorax and infection are a few possible complications. Horner's syndrome, in which there is a drooping of the upper eyelid, permanent constriction of the pupil, or no facial sweating on the same side of the surgery are symptoms associated with this condition. These are rare as well.