Treatment for Hand Sweating

Excessive hand sweating, or palmar hyperhidrosis, can be socially and professionally disabling. Simple tasks like shaking hands, writing, or using a smartphone can become uncomfortable or even impossible. For individuals whose symptoms don’t respond to non-surgical treatments, Endoscopic Thoracic Sympathectomy (ETS) may offer lasting relief.

ETS targets the sympathetic nerves responsible for stimulating sweat glands in the hands. Evidence shows that ETS, in a fully informed individual, significantly improves quality of life in most patients, although 2–4% may experience regret due to side effects.

The choice to proceed with surgery for hand sweating must be carefully considered, balancing the benefits with the potential risks. This decision is best made after individual assessment.

Advanced ETS surgery

ETS is performed under general anaesthetic using “keyhole” surgery. Two small incisions (each around 0.5 cm) are made in the armpits. The sympathetic nerve is divided, and the wounds are closed with dissolvable sutures. The procedure takes approximately 40 minutes, and a post-operative chest X-ray is used to confirm full lung expansion. Scarring is minimal.

Download ETS Patient Leaflet

Contraindications to Surgery

ETS is not suitable for:

  • Elderly patients

  • Those with cardio-respiratory disease

  • Individuals who are obese

  • Patients with a history of significant chest disease or prior chest surgery

The procedure is generally irreversible, as the treated nerve does not regrow. Although there are different techniques (cutting, clipping, burning), ETS is only potentially reversible in about 20–30% of cases.

Post-Operative Course

Some patients may experience sharp pain near the wounds or in the upper back, which usually subsides quickly. Return to work is often possible within 2 days, but this can vary. Physical activities can typically resume after two weeks.

Complications and Side Effects

Life-threatening complications have not occurred in our experience, but because the surgery involves the chest, there is a rare risk that the chest may be opened in case of bleeding. Very occasionally, a lung air leak may require a temporary suction drain.

Other possible effects include:

  • Prolonged arm pain or numbness (uncommon)

  • Horner’s syndrome (less than 1% incidence, usually temporary)

  • Wound or chest infection (less than 5%)

  • Excessively dry hands requiring moisturisers

  • Compensatory sweating, typically on the torso or legs, which may lead 1 in 50 patients to regret surgery

Gustatory sweating occurs in up to 30% of individuals but is rarely a major concern. Though some people report general fatigue, stress testing shows no reduction in physical performance, despite a mild (around 10%) drop in heart rate.

How Can Treatment Help?

These conditions can be significantly improved through highly selective nerve treatments, such as endoscopic thoracic sympathectomy (ETS). This minimally invasive procedure interrupts nerve signals responsible for blushing and sweating, reducing or stopping symptoms and improving quality of life.

Make an enquiry