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Vascular Occlusive Syndromes of the Upper Extremity Clinical Presentation

  • Author: Bradon J Wilhelmi, MD; Chief Editor: Harris Gellman, MD  more...
Updated: Jan 23, 2015


Patient evaluation for suspected vascular pathology should include eliciting detailed descriptions of the following:

  • Trauma mechanism (penetrating or nonpenetrating)
  • Exposure to repetitive insults
  • History of familial or blood disorders
  • Drug or tobacco use
  • Any concurrent illness

Patients with insidious vascular compromise may initially report numbness, increased pain, or cold sensitivity. As vascular insufficiency progresses, patients may report weakness or even present with frank gangrene resulting from tissue necrosis.



A complete physical examination of the entire upper extremity and neck is warranted. The following must be documented:

  • Capillary refill
  • Skin turgor
  • Signs of infection
  • Tissue compromise, such as ulceration or gangrene
  • Quality of pulses
  • Presence of masses, bruits, or both

An Allen test should be performed to differentially evaluate the patency of the ulnar and radial arteries at the distal forearm. Documenting time-to-refilling is valuable for serial examinations. Additionally, several diagnostic evaluations may be completed to confirm suspected diagnoses (see Workup, Imaging Studies).



Causes of vascular compromise include the following:

  • Acute trauma
  • Chronic modalities, such as repetitive microtrauma
  • Systemic disease processes involving metabolic or autoimmune processes
Contributor Information and Disclosures

Bradon J Wilhelmi, MD Leonard J Weiner Professor and Chief of Plastic Surgery, Plastic Surgery Residency Program Director, Hiram C Polk Jr Department of Surgery, University of Louisville School of Medicine

Bradon J Wilhelmi, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for Hand Surgery, American Society for Reconstructive Microsurgery, Association for Surgical Education, Plastic Surgery Research Council, American Association of Clinical Anatomists, Wound Healing Society, American Society for Aesthetic Plastic Surgery, American Burn Association, American College of Surgeons, American Society for Surgery of the Hand, American Society of Plastic Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

N Ake Nystrom, MD, PhD Associate Professor of Orthopedic Surgery and Plastic Surgery, University of Nebraska Medical Center

Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami, Leonard M Miller School of Medicine, Clinical Professor, Surgery, Nova Southeastern School of Medicine

Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, Arkansas Medical Society

Disclosure: Nothing to disclose.

Additional Contributors

Joseph E Sheppard, MD Professor of Clinical Orthopedic Surgery, Chief of Hand and Upper Extremity Service, Department of Orthopedic Surgery, University of Arizona Health Sciences Center, University Physicians Healthcare

Joseph E Sheppard, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Orthopaedics Overseas, American Society for Surgery of the Hand

Disclosure: Nothing to disclose.


Arian Mowlavi, MD, FACS Consulting Staff, Department of Plastic Surgery, Cosmetic Surgery Clinics of Laguna Beach

Arian Mowlavi, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, American Medical Association, and Phi Beta Kappa

Disclosure: Nothing to disclose.

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