Hyperhydrosis

This is the medical term for excessive sweating.  It usually involves the hands, but also the armpits and even the feet in a small percentage of patients are affected.  The clammy hands are a source of embarrassment for many people as hand shaking is the commonest way of greeting each other.

This can be managed with a procedure called a Thoracoscopic Sympathectomy. In this procedure, the patient is anaesthetized then 2 or 3 ports are placed between the ribs.  Through one of these a camera can be placed to show the sympathetic chain in the chest. These are the nerves that are responsible for sweating.  This chain is then interrupted at 2 levels using instruments placed through the other ports.

The procedure is more than 90% effective, involves an overnight stay. Each wound is about 3-4 cm long and hidden under the arm.

The risks of the operation are:

If the sweating is mainly affecting the armpit then the operation may not completely shut this off.  In a small percentage of patients when the sympathetic nerves of the arm are switched off then other sweat glands can overreact. This can affected the groin and cause excessive sweating.

In any operation there is a risk of damaging adjacent anatomical structures.  This can cause a Horners Syndrome – uneven pupils and a ‘tired eye’.  Neuralgia - which is pain caused by damaged nerves in the arm. 

There is a small chance the chest may need to be opened if  major complications occur.

Thoracic Outlet Syndromes

These is a group of conditions that result from compression of veins, nerves or arteries of the upper limb as they pass from the chest to the arm through an anatomical space (the thoracic outlet) that may become narrowed.

The symptoms depend on which structures are compressed.  If the vein is involved then a clot or DVT can form and the arm may suddenly swell.  If the nerves are involved then pain or pins and needles may develop.  If the artery is involved then muscular pain, early fatigability and painful purple fingers can develop.

Diagnosis requires a careful examination and special imaging often with MRI or angio or venography.

Treatment is centred on decompressing the outlet – this is usually done by surgically removing the first rib as well as treating the affected structure.  For example, unblocking the vein, repairing the artery or freeing up the nerves.