Raynaud's Phenomenon

Raynaud's phenomenon is a state related to temporary whitening of some fingers (or their parts) of the upper extremities. It may seem to be just a cosmetic problem, but some forms are painful and they can even damage the fingers and result in their necrosis and amputation. We sometimes differentiate the Raynaud's disease (primary Raynaud's phenomenon) and Raynaud's syndrome (secondary Raynaud's phenomenon). The disease has no clear reasons and it occurs primarily, while the syndrome is caused by other pathology. 

Causes

The primary Raynaud's disease is caused by a sudden narrowing of small arterioles supplying the fingers. Inadequate blood an oxygen supply lead to whitening of the skin of the fingers. The reason of local arterial constriction is not clear. The constriction lasts from few minutes to dozens of minutes. After that, the arterioles reopen and the fingers turn red. Primary Raynaud's disease is more common in women and it tends to have a relationship to cigarette smoking, cold environment and stress.

 

Secondary Raynaud's phenomenon is also caused due to inadequate blood supply to fingers, but in this case, the causative factor is clear. The possible causes may include:

Cervical rib syndrome

Some people have an extra cervical rib, which is positioned closely to the subclavian artery and the artery may get compressed. This artery supplies the whole arm, elbow and hand including the fingers. Arterial compression may result in whitening of various parts of the arm including the fingers.

Local tumors

Some tumors may compress subclavian artery and cause local hypoperfusion of the affected arm. This situation is typical for the so-called Pancoast tumor, which is a form of lung cancer, when the tumor mass is located at the top of the lung closely to the subclavian vessels.

Autoimmune diseases

Some of these diseases manifest with inflammation of the blood vessels (vasculitis) resulting in disruption of blood supply to tissues. The typical examples are certain forms of systemic lupus erythematosus.

Work with vibrating tools

Prolonged exposure to vibrations interferes with the vessel walls and it may cause their narrowing. The most affected are the hand arteries. The problems have been reported mainly in people working with a pneumatic drill.

Symptoms

Raynaud's phenomenon may be very variable. Some forms cause only temporary skin discoloration of the fingers, or their parts, and local painful sensations. The whitish color of the skin lasts for only a short time and it is alternated with subsequent flushing due to blood congestion in reperfusion.

 

Severe forms of the phenomenon may cause serious disruption of blood and oxygen supply and threaten the affected tissues. Local necrosis followed by gangrene is the most feared complication that may force the doctors to amputate the damaged finger.

 

Raynaud's phenomenon

 

Scheme - Raynaud's phenomenon

 

Diagnosis

When a patient suffers from whitening of the fingers, it is necessary to exclude the possible causes of the secondary Raynaud's syndrome. The doctor should palpate the pulse on the affected arm to exclude its total hypoperfusion. The possible imaging methods include chest X-ray and computed tomography to exclude local compression of the subclavian artery and angiography may be performed to visualize the arterial system of the affected upper extremity.

Treatment

When the Raynaud's phenomenon is caused by another disease, it is necessary to solve the underlying cause (when possible). The primary Raynaud's phenomenon is usually very difficult to treat. Usually, we focus on prevention of the bouts associated with whitening and pain of the fingers. The patients should avoid cold environment and wear warm gloves. Smoking is strictly forbidden. Medications causing dilation of arteries are prescribed, but their effects are not always convincing.