Elbow / Wrist / Hand

Raynaud Phenomenon

Definition

Raynaud phenomenon is described as being a sign of infection with vascular insufficiency of the distal extremities, resulting in whitening of the fingers and/or toes, followed by blue discolouration. Both phases are accompanied by pain and function restrictions.

Aetiology

The Raynaud phenomenon is seen fairly frequent and has an incidence of 3-21%.

There is a primary form known as Raynaud's disease, and a secondary form known as Raynaud phenomenon. The aetiology of the primary form is unknown.

Raynaud phenomenon is often a manifestation of system diseases, such as scleroderma, Sjögren disease, rheumatoid arthritis, SLE, polymyositis, or a peripheral vascular infection such as trombangeitis obliterans or Buerger's disease. Raynaud phenomenon can be a side effect of some types of chemotherapy (cisplatinum, bleomycine or vincristine).

The exact pathophysiological mechanism is not clear. It has been proved that physiological vasoconstriction due to nor-adrenaline, is enhanced by cold and increased sensitivity, and exists for α2-agonists and serotonin. The highly vasoconstrictive endothelin-1 also plays a role.

Signs and symptoms

In Raynaud syndrome, the fingers and/or toes suddenly become cold and pale. They then turn blue and eventually, when 'warm' again, turn red. This may be accompanied by pain or a glowing sensation. The symptoms may persist for from five to 30 minutes. Sometimes ulcers occur.

Diagnostics

Physical Examination

In Raynaud syndrome, internal medical/rheumatologic evaluation is of primary importance to exclude a primary aetiology. Inspection of the hands and feet for wounds, ulcers, and the presence of dilated capillaries in the nail bed are also important.

Additional Somatic Diagnostics

  • Additional blood tests (CRP, antibodies, kidney function) focused on autoimmune diseases can better be performed by an internal medicine specialist or a rheumatologist.
  • No imaging techniques are indicated in Raynaud syndrome.
  • Estimation of transcutaneous oxygen saturation can be used as a parameter for the severity of the syndrome.

Somatic Treatment

The primary form of Raynaud syndrome has a benign course and can generally be conservatively treated without medication. It should be enough to inform the patient and to advise him to avoid eliciting factors by dressing up warmly, stopping smoking, taking adequate exercise, and avoiding drugs with a vasoconstrictive effect.

The treatment of the secondary form of Raynaud syndrome is primarily focussed on the underlying disease.

Pharmacological treatment:

Anti-inflammatories

  • Nifedipine (Ca+-antagonist) and prazosine (α1-blokker).

Analgesics

  • Gabapentin, ketamine IV are probably effective.

Vasodilatators

  • Calcium influx blockers, ketanserine.

Spasmolytics

  • Oral benzodiazepines or baclofen.
  • Intrathecal  baclofen in patients with dyskinesia.

Other Treatments

Interventional Pain Treatment