When I began my career at the University of Pittsburgh I was blessed to work with Dr Thomas Medsger--a rheumotologist and world authority on Sceroderma. I had the opportunity to treat patients from all over the country for digital ulceration and pain, as well as joint contracture.
Palmar sympathectomy is a microsurgical procedure aimed at removing the sympathetic nerve connections to the ulnar artery, radial artery and palmar arch vessels--to prevent vasoconstriction and improve nutritional blood flow to the fingertips. In addition, adventitial fibrosis is removed--much like opeing up the casing around a sausage.
I have published my results in several journals and have found that patients are able to stop taking their narcotic pain pills, although most continue to take their vasodilator meds. From each patient's perspective, this surgery has been most satisfactory--most have returned to have the procedure performed on their other hand as well.
2 comments
tmcc73 12/11/10 at 9:58 pm
Here you talk about what appears to be the extreme end of schleroderma and its association with Raynaud's phenomenon. You mention that the surgery's are complete enough for patients to stop pain meds but they continue to take the vasodilator. Can you offer any comments for patients at the early stages of Raynaud's and success of taking the vasodilator? A few months ago I was diagnosed with Raynaud's in my toes...pain, cold, discoloration, and ulcers. Vasodilators helped minimize the symptoms, but now I am beginning to experience the same cold intolerance and pain in my fingertips. I am trying to decide if the side effects are worth dealing with in order to continue with the meds for the symptoms.
Thanks!
tmcc
mtomaino 12/13/10 at 3:04 pm
The vasodilators typically improve perfusion (blood flow) by "opening up the blood vessels." The pain associated with cold intolerance is often "ischemic pain." There are a number of alternative meds as well as doses. Procardia (Nifedipine) is a common one. I would suggest that you discuss this with your Family Doctor or consider seeing a Rheumotologist. It goes without saying that "smoking" is a bad think when it comes to these types of symtoms----so if you smoke, try to stop! As a hand Surgeon, my exam would seek to rule out any type of vascular occlusion, and if you do not respond to medical treatment, I would likely send you for some Non-invasive vascular studies.
Matt