Raynaud's phenomenon

What is Raynaud's phenomenon?

Raynaud's phenomenon is a circulatory disorder in which the blood flow to the fingers and toes is temporarily diminished. The small blood vessels (arteries) supplying finger and toes contract suddenly, often upon exposure to cold or stress.

Symptoms usually begin at the tips of the fingers and toes and gradually spread to involve more of the digits. Episodes may last from minutes to hours. The fingers, usually on both hands, are affected more often than the toes. Although the exact cause for the blood vessel constriction (vasoconstriction) is unknown, there are several theories.

The blood vessel constriction may be due to increased nervous system stimulation to the vessel walls. Raynaud's phenomenon is a recognized occupational disorder of individuals who use pneumatic drills, chain saws, or other vibrating hand tools and machinery.

This disorder is also seen in occupations involving repeated finger trauma, such as typing and playing the piano. Because it is often associated with connective tissue diseases such as rheumatoid arthritis, scleroderma, and systemic lupus erythematosus, vasoconstriction may be the result of an antigen-antibody immune response. Other possible causes include arterial diseases such as Buerger's disease, atherosclerosis, embolism, and thrombosis.

Certain drugs (beta-blocker, ergotamine, vasoconstrictor, and nicotine from cigarette smoking or chewing tobacco) are also associated with Raynaud's phenomenon.

The disorder may occur secondary to frostbite, leading to a theory that the vessel walls may be intrinsically hyperreactive to cold.

Raynaud's phenomenon is the result of a known underlying disorder and may have serious long-term consequences. When symptoms occur from no known cause, it is called Raynaud's disease. This disorder commonly affects healthy young females.

How is it diagnosed?

History: On exposure to cold, individuals may report that fingers or toes turn white, become bluish in color (cyanosis) and then, with heat or warmth, become red. Pain, tingling, numbness, or burning often occurs in the affected fingers or toes. In more severe or chronic cases, the skin may eventually become smooth, shiny, and tight, and ulcerations may appear at the tips of the affected digits. In the most severe cases, gangrene (tissue death) may develop as a result of severely reduced blood flow. Diagnosis is based in part on the individual's history, including the recurrence of symptoms for at least two years.

Physical exam: Cold or stress induced skin color changes may occur, usually on both sides of the body. Severe or chronic cases may display shiny, tight skin, with ulcers on the fingertips. Gangrene is present only in the severest of cases.

Tests are used to rule out carpal tunnel syndrome as the underlying cause of the symptoms and include a cold challenge test, plethysmography (device for monitoring the amount of blood contained or passing through a body part), and segmental nerve conduction studies. Peripheral vascular studies may also be performed. Additional diagnostic testing may include tests to identify arterial occlusion, diabetes, or thyroid disease.

How is Raynaud's phenomenon treated?

Symptoms are generally relieved by heat. Besides protecting the body (especially hands and feet) from cold, treatment is directed at the underlying disorder.

• The use of vibrating machinery or tools should be discontinued or minimized.
• Cigarette smoking, chewing tobacco and emotional stress should avoided.
• If symptoms are the result of medications, the drugs may need to be changed or discontinued.
• Vasodilator drugs, which relax the walls of the blood vessels, may be used in individuals with unusually severe symptoms.
• In cases where ulcers develop in spite of other treatments, a sympathectomy may be used in an effort to improve blood flow to the skin. This procedure is necessary in less than 25% of individuals with Raynaud's phenomenon.

Medications

Information	Brand	Generic	Label	Rating
	Viagra	Sildenafil

Prozac (Fluoxetine), Cardura (Doxazosin), Adalat (Nifedipine), Norvasc (Amlodipine)

What might complicate it?

The walls of the arteries may gradually thicken and permanently reduce blood flow, which may lead to painful ulcerations or gangrene (tissue death) at the tips of the affected digits. Rarely, amputation may be required due to gangrene.

Predicted outcome

The outcome is extremely favorable provided adequate treatment is obtained. Few cases are so severe as to require radical treatment for ulceration or amputation for gangrene.

Alternatives

Conditions with similar symptoms include diabetes, thyroid disease, neuropathy, autoimmune disease, carpal tunnel syndrome, or chronic arterial occlusive disease. Use of certain medications such as those used to treat hypertension or asthma can also diminish peripheral circulation.

Appropriate specialists

Internist, cardiovascular specialist and neurologist.

Last updated 23 December 2015