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Digital Artery Conditions
 
Basic Facts
Raynaud's phenomenon is a disorder in which the fingers or toes suddenly and temporarily develop impaired circulation, most commonly in response to cold, and then change color, turning white, then blue, and then with rewarming, red.
The primary form of Raynaud's phenomenon is commonly referred to as Raynaud's disease and is not associated with any other medical disorder. Women are 9 times more likely than men to develop Raynaud's disease.
Secondary Raynaud's phenomenon is more complicated, often more severe, and may be associated with other medical conditions such as scleroderma or other connective tissue diseases, or less commonly, arteries blocked from atherosclerosis or thoracic outlet syndrome, nervous system disorders, blood disorders, frostbite, vibration injury, or the use of certain medications.
Raynaud's phenomenon is a condition in which one or more fingers or toes become pale or blue because of cold temperature or emotional stress. Raynaud's phenomenon can be classified as one of two types: Primary, also called Raynaud's disease, is not associated with any other medical disease, and secondary, which is caused by or associated with other medical conditions.

WHAT ARE THE SYMPTOMS?

Usually, three phases of symptoms occur during an episode of Raynaud's phenomenon. Initially, the digits turn pale or white as blood flow decreases. Then the digits turn a bluish shade because they lack oxygen; the digits will often feel cold, numb, and tingly at this stage. Finally, the blood vessels reopen (dilate), which causes the digits to redden and throb painfully. These attacks can last anywhere from less than a minute to several hours.

In the most serious form of Raynaud's phenomenon, the affected digits can develop deep sores (ulcers), or the tissue may become gangrenous.

CAUSES AND RISK FACTORS

It is not known what causes the blood vessels in the digits to spasm, although abnormal nerve control of the diameter of the blood vessel and nerve sensitivity to cold are suspected contributors.

Secondary Raynaud's phenomenon has been associated with a number of medical conditions, including:
  • Scleroderma;
  • CREST syndrome (Calcinosis, Raynaud's pheomenon, Esophageal dysmotility, Sclerodactyly, and Telangiectases);
  • Connective tissue diseases;
  • Diseases that result in blockages of arteries;
  • Blood disorders;
  • High pulmonary artery pressure caused by diseased arteries in the lungs;
  • Nervous system disorders; and
  • Injuries or traumas.
Other factors that contribute to Raynaud's phenomenon include:
  • Medications; and
  • Smoking.
DIAGNOSIS

In patients whose digits change color in the typical white, blue, and red sequence, the diagnosis of Raynaud's phenomenon is not difficult to make. However, diagnosis of secondary conditions requires a number of tests, including:
  • Blood tests;
  • Nailfold capillary study; and
  • Cold water immersion test.
TREATMENT APPROACH

There is no known way to prevent the development of Raynaud's phenomenon. Patients with Raynaud's phenomenon are asked to:
  • Stay warm;
  • Cover their hands and feet well in cold weather;
  • Protect their fingers and toes from trauma and infection;
  • Avoid exposure to secondhand smoke; and
  • Quit smoking.
The physician may also suggest substitutions for medications that may be triggering symptoms. About 50 percent of patients with primary Raynaud's improve with these precautions.

Patients with severe cases of Raynaud's phenomenon may need to be treated with prescription medications or a surgery called digital sympathectomy.

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