Raynaud's Phenomenon
Description
Raynaud’s Phenomenon is considered a local defect caused by spasms of the digital arteries that results in discoloration of the skin of the fingers or toes occurring bilaterally and intermittently. There are three pathophysiologic mechanisms: vascular, neural and intravascular abnormalities. These mechanisms can vary depending on the classification of Raynaud’s (Primary or Secondary).
Signs & Symptoms
Primary
Secondary
- No associated autoimmune disease
- <30 years age of onset
- Infrequent pain with attacks, onycholysis and/or pterygium inversum, Tuft pits and/or necrosis
- Symmetrical finger involvement
- Normal nailbed capillaries
- Negative or low tiers of autoantibodies
Secondary
- Associated autoimmune disease
- >30 years age of onset
- Frequent pain with attacks, onycholysis and/or pterygium inversum, Tuft pits and/or necrosis
- Asymmetrical finger involvement
- Dilated with “vessel dropout” nailfold capillaries
- Elevated autoantibodies
Diagnostic Tests
- Adson’s maneuver to rule out anatomic anomaly
- Absence of any causal disease & duration of symptoms >2 years
PT Implications
- Be sure to ask patient about current medications
- Primary (and most secondary cases) patient education for lifestyle modifications
- Wearing thermal underwear, scarves, heat-conserving hats, and insulated footwear during cold months
- Avoid sudden temperature changes (A/C from hot environment)
- Refrain from using pharmacologic agents that promote vasoconstriction (decongestants, amphetamines, B-blockers & caffeine)
- Cessation of smoking
- Increase vasodilation by:
- Rotating arms in windmill pattern
- Placing hands under warm water or body parts
- Swing arm maneuver- raise both arms over shoulders and forcefully swing arms across body