Raynaud’s phenomenon

161 Raynaud’s phenomenon



Instruction


Examine this patient’s hands.



Salient features



History




• Ask the patient about the following:


• Whether precipitated by cold, emotion and relieved by heat

• The different phases change: in idiopathic Raynaud’s disease, the cold dead-white hands (ischaemia) become blue (stasis) and finally red (reactive hyperaemia) and painful

• Sensory changes secondary to vasospasm (numbness, stiffness, aching pain)

• Occupation (polishing tools, vibrating tools)

• Dysphagia (CREST syndrome)

• Butterfly rash, arthralgia, xerostomia (SLE, collagen vascular disorder)

• Use of electrically heated gloves.


Examination




• Hands may be painful: ask the patient.


• The hands and fingers are cyanosed and cold, or may be warm and red or blue (Fig. 161.1). The thumbs are rarely affected.


image

Fig. 161.1 Scleroderma showing Raynaud’s phenomenon: pallor, cyanosis, and often rubor of the skin, in response to cold or emotional stimuli.


Proceed as follows:



• Examine the hands carefully for signs of scleroderma (tightening of skin, telangiectasia).


• Examine the face for tightening of skin around the mouth (scleroderma), butterfly rash (SLE).


• Tell the examiner that you would like to examine upper limb pulses and BP in both upper limbs (useful in the detection of cervical rib).



Diagnosis


This patient has cold, blue hands (lesion) caused by Raynaud’s phenomenon (aetiology) and is unable to continue her occupation, which requires using a vibratory hand drill (functional status).



Advanced-level questions




How is primary Raynaud’s differentiated from secondary Raynaud’s phenomenon?




• Primary:


• Attacks are symmetric

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Dec 4, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Raynaud’s phenomenon

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