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Raynaud’s Phenomenon

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What is Raynaud’s Phenomenon

There are a variety of blood vessel diseases that can cause vasoconstriction and vaso-occlusion (squeezing or blocking of blood vessels). One of the most common vascular diseases is Raynaud’s Phenomenon, which is sometimes thought of as “cold hand.” Vasoconstriction, or the shrinking of blood vessels, naturally occurs to help the body core retain heat, but Raynaud’s can occur when the tiny blood vessels of the fingers hyper-respond to the cold.

15–20% of all women experience an episode at one time or another, but if it recurs, it may signal an underlying medical condition. While it is not usually dangerous, periods of constricted blood flow lasting more than 15 minutes can begin to starve tissue of oxygen, so prompt warming action is important.

Raynaud’s disease includes a hypersensitive reaction to cold that is not paired with any other vascular disease, and is sometimes known as “primary Raynaud’s.”

Raynaud’s phenomenon is a reduction in the blood flow to the hands as a result of cold temperatures, causing a color change in some portions of the hands and, most notably, the fingers, that exists alongside another vascular or autoimmune disease (such as lupus, scleroderma or rheumatoid arthritis). This is sometimes known as “secondary Raynaud’s.”

 

Causes

Primary Raynaud’s is thought to be at least partly hereditary, although the specific genes have yet to be identified. In primary Raynaud’s, when it is not paired with another vascular condition, it usually has no known origin. It most commonly affects women, particularly those with small frames, where the viscous blood has narrower vessels to push through to reach the fingers. Low blood pressure is also a contributor.

Secondary Raynaud’s is more common and accompanies an underlying autoimmune disease, such as scleroderma or lupus, or more rarely, another syndrome or disease. Commonly paired diseases include: systemic lupus erythematosus, scleroderma, systemic sclerosis, Rheumatoid Arthritis, CREST syndrome, Sjogren’s syndrome, Buerger’s disease (Thromboangitis Obliterans), and obstructive arterial disease.

 

Sign & Symptoms

The color changes are usually dramatic, from white, as the blood flow slows and stops, to blue when deoxygenated venous blood, having no push from the arterial side, pools in the fingers. Finally, the fingers grow red when the vasoconstriction resolves and blood rushes back in, usually within 15 minutes removed from the source of the cold temperatures.

  • Fingers feel cold
  • Fingers turn pale or white and then blue
  • Numbness or tingling
  • Finger/ hand clumsiness
  • Pain (although not a common symptom)
  • Fingers turn red, throb, tingle, burn, or feel numb as blood flow returns to the affected areas

 

Diagnosis & Treatment

Once a diagnosis is made, hand specialists work in conjunction with rheumatologists and primary care physicians to evaluate the best treatment options. The means of reducing episodes of Raynaud’s phenomenon are the same.

Education and Prevention

As a front line of the defense, learn about the syndrome and become attuned to the triggers. You can help stave off episodes by trying to avoid putting stress on blood vessels. Wearing loose fitting sleeves can minimize external constriction. Dressing in layers allows for more flexibility with climate changes. Keeping gloves and chemical hand warmers within close proximity can prevent or reverse a developing episode. Also, avoiding direct contact with cold items like beverage containers and steering wheels is helpful.

Certain medications and behaviors are associated with heightened or more frequent episodes, so try to avoid these vasoconstrictors: smoking, over-the-counter cold medications that contain pseudoephedrine, heavily caffeinated drinks, narcotics, ergotamines and serotonin receptor drugs used for depression or migraines.

Therapies

Temperature biofeedback training has proven successful in many patients. Once you become aware of the physical sensations that precede an episode, you can learn to exercise some control over your body’s responses to the temperature trigger.

With stress, our bodies release vasoconstricting hormones, so relaxation therapy such as practicing meditation, can be effective in teaching you to “lower the decibels” in your response to stressors. Improving cardiovascular health can be very effective, since the rigors of regular exercise increase the suppleness of the blood vessel walls and also allow the body to grow additional vessels, serving as potential detour routes for the blood to take on its way to the extremities.

If frequent or intense episodes of Raynaud’s phenomenon affect the quality of your life, your doctor will likely recommend you take one of many medications that work as vasodilators. The combination of medication and other therapies are often sufficient to vastly improve symptoms.

Surgery

If you are not helped by these medications and therapies, surgery can be performed to separate the outer layer of the arterial vessels from the nerves, relieving pain and increasing blood flow.

 

Recovery

If we opt for surgical treatment, you will be protected afterward with a bulky dressing to your hand, wrist and forearm, and stitches will be removed in around two weeks. Physical therapy is often recommended until normal motion comes back without pain.

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