Raynaud Phenomenon Clinical Presentation

  • Author: Heather Hansen-Dispenza, MD; Chief Editor: Herbert S Diamond, MD   more...
 
Updated: Sep 22, 2011
 

History

Numbness and pain in the affected area or areas may be present.

Affected areas show at least two color changes: white (pallor), blue (cyanosis), and red (hyperemia). The color changes are usually in the order noted, but not always. These changes should be reversible but may, in severe cases, lead to local ischemia and ulceration.

Any history of associated symptoms should raise suspicion of an underlying disorder. History of other vasospastic symptoms such as migraines may be useful.

Obtain occupational history.

  • Secondary Raynaud phenomenon has been associated with the frequent use of vibrating tools such as jackhammers and sanders. See the image below. Photo of a patient with Raynaud phenomenon that rePhoto of a patient with Raynaud phenomenon that resulted from working with a jackhammer. Courtesy of the CDC.
  • Industrial exposure to polyvinyl chloride has been implicated.
  • Any history of injury or frostbite may leave the involved limb vulnerable to vasospasm.
  • Raynaud phenomenon may be associated with laboratory work, with exposure to organic solvents such as xylene, toluene, acetone, or chlorinated solvents.[18]

Syndromes associated with Raynaud phenomenon include the following:

Syndromes that may be confused with Raynaud phenomenon are as follows:

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Causes

The cause of primary Raynaud phenomenon remains unknown.

Possible causes for secondary Raynaud can be divided into several broad categories, including the following:

  • Occupational
  • Hematologic
  • Collagen-vascular (autoimmune)
  • Medication-induced
  • Miscellaneous syndromes such as Fabry disease, pheochromocytoma, lung adenocarcinoma, acromegaly, carpal tunnel syndrome, and myxedema

Although the following entities do not usually have the same inciting causes, nor do they encompass the usual color changes associated with Raynaud phenomenon, they can easily be mistaken for Raynaud phenomenon:

  • Vasculitis
  • Carpal tunnel syndrome
  • Reflex sympathetic dystrophy
  • Thromboembolic disease
  • Thoracic outlet syndrome
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Physical Examination

Carefully examine digits if either primary or secondary Raynaud is suspected.

  • Observe for sclerodactyly, calcinosis, or digital ulcers.
  • Examine nailfold capillaries under magnification from a dissecting microscope or ophthalmoscope to help diagnose underlying autoimmune disorders. Abnormalities often appear in patients with early scleroderma. The normally regular pattern of capillary loops is replaced with abnormally large loops, alternating with areas without any capillaries.
  • A cold challenge test can trigger Raynaud phenomenon in the office setting but is not usually necessary to make the diagnosis.
  • A sharp demarcation of the border between the affected and unaffected areas is required for diagnosis. Many patients do not have classic triphasic color changes.

Evaluate any signs or symptoms of other syndromes associated with secondary Raynaud.

  • Bone pain may suggest a paraneoplastic syndrome associated with a hyperviscosity syndrome.
  • The presence of nephritis, malar erythema, and arthritis suggests systemic lupus erythematosus.

Persistent cyanosis or necrotic distal tissue suggests an underlying disorder or permanent ischemia. Livedo reticularis suggests an autoimmune disorder or coagulation abnormality.

Carpal tunnel syndrome has been associated with an increased frequency of Raynaud phenomenon.

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Contributor Information and Disclosures
Author

Heather Hansen-Dispenza, MD  Rheumatology Fellow, University of Arizona College of Medicine

Heather Hansen-Dispenza, MD is a member of the following medical societies: American College of Physicians and American College of Rheumatology

Disclosure: Nothing to disclose.

Coauthor(s)

S Anita Narayanan, MD  Fellow in Rheumatology, University of Arizona College of Medicine

S Anita Narayanan, MD is a member of the following medical societies: American College of Physicians, American College of Rheumatology, and American Medical Association

Disclosure: Nothing to disclose.

Jeffrey R Lisse, MD, FACP  Professor, Department of Internal Medicine, Chief, Section of Rheumatology, University of Arizona School of Medicine

Jeffrey R Lisse, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, American College of Rheumatology, American Geriatrics Society, and Sigma Xi

Disclosure: Genentech Consulting fee Consulting; Centacor Consulting fee Consulting; Novartis Consulting fee Review panel membership

Mayra Oberto-Medina, DO  Fellow, Section of Rheumatology, University of Arizona

Disclosure: Nothing to disclose.

Specialty Editor Board

John Varga, MD  Professor, Department of Internal Medicine, Division of Rheumatology, Northwestern University

John Varga, MD is a member of the following medical societies: American College of Physicians, American College of Rheumatology, Central Society for Clinical Research, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

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

Disclosure: Medscape Salary Employment

Elliot Goldberg, MD  Dean of the Western Pennsylvania Clinical Campus, Professor, Department of Medicine, Temple University School of Medicine

Elliot Goldberg, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, and American College of Rheumatology

Disclosure: Nothing to disclose.

Alex J Mechaber, MD, FACP  Senior Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine

Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Chief Editor

Herbert S Diamond, MD  Adjunct Professor of Medicine, Division of Rheumatology, University of Pittsburgh School of Medicine; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital

Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, American Medical Association, and Phi Beta Kappa

Disclosure: Merck Ownership interest Other; Smith Kline Ownership interest Other; Zimmer Ownership interest Other

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A 9-year-old with Raynaud phenomenon. Notice the discoloration of the fingers.
Photo of a patient with Raynaud phenomenon that resulted from working with a jackhammer. Courtesy of the CDC.
 
 
 
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