Post-traumatic reflex sympathetic dystrophy (RSD) of the upper extremity followed by a sympathectomy (surgical removal of portions of the sympathetic chain ganglia). In this case, RSD originates in the hand, follows a course to the brain, and triggers a sympathetic inflammatory response in the hand, resulting in pain, swelling and skin mottling. We see the location of the sympathetic chain ganglia alongside the spine with a section of the gangla removed from vertebral levels T6, T7, T8 and T9.