Vascular disorders of the hand and upper extremity are uncommon, but when they do occur, they may have lasting implications.
Arteries bring oxygenated blood from the heart to the fingertips, and veins return the used blood back to the heart and lungs. At the level of the wrist, two major arteries bring blood into the hand: the radial and ulnar arteries. Variations in the anatomy are common, however, which may affect the way blood flow ultimately reaches each finger.
There are many causes of vascular problems, which can be classified into five groups: traumatic, compressive, occlusive, tumors/malformations, and vasospastic (spasm of the artery, which reduces its diameter and thus its blood flow).
Vascular problems may occur more commonly in dialysis patients or individuals with certain diseases such as diabetes, hypertension, or kidney failure. Occupational exposure such as being in the cold or using vibrating tools can be a factor, and smoking also can aggravate and cause vascular disease.
Several other conditions may cause or have other correlations with vascular disorders of the hand.
Trauma
Penetrating trauma such as a knife wound may damage the blood vessel. Occasionally, a seemingly innocuous cut appropriately located will cause major damage, or sometimes a blunt injury can bruise the vessels enough to cause a clot and stop the blood from flowing to the fingertips, which turn white, cold, and painful. Immediate reconstruction is usually necessary if blood flow has stopped.
Other injuries may not be as severe, since there may be a variety of different arteries that can continue to provide blood flow to the area.
Aneurysms
An aneurysm is a localized weakness of the vessel wall that results in an isolated expansion of the vessel, like a balloon popping up. Usually these present as a soft painless mass over the vessel. The vessel may become blocked through the formation of a blood clot or may even shower small clots to the fingertips.
Aneurysms of the wrist may cause cold intolerance, pain, or numbness as they enlarge, and they can occasionally cause gangrene of the fingertips.
Vascular Malformations
When an abnormal connection exists between the veins and arteries, excess blood is shunted through these small vessels, which may become large and produce symptoms. When a significant volume of blood is redirected through these small connecting vessels, patients can experience pain, sweating in the area, heaviness, increased temperature and hair growth, and spontaneous bleeding.
When small, treatment may be as simple as a compression glove. However, when large and destructive, treatment might require surgical excision.
Raynaud’s Disease
Raynaud’s disease/phenomenon describes a condition in which the arteries in the fingers go into spasm, depriving the finger of blood flow. The fingers typically change color, going from white to blue then red as the spasm resolves and blood flow returns. It often occurs when the hand is exposed to cold or tobacco.
Treatment entails cessation of smoking, avoiding cold weather, use of protective garments (e.g. mittens, gloves), and occasionally use of medicines that can help dilate the vessels and improve blood flow to the fingertips. When unresponsive to these measures or a non-healing ulcer is present, surgery to separate the nerves from around the vessels may be considered to relieve the effect of the sympathetic nerves that contribute to spasm of the arteries.
Many of the signs and symptoms of vascular disorders are clear, as they tend to be visible and cause various emotional and physical effects. Some of the most common signs include:
If you are experiencing these symptoms, make an appointment to see our hand surgeon in Howell in Livingston County, West Bloomfield in Oakland County, or Warren or Macomb Township in Macomb County.
For a proper diagnosis, your examination may include identification and analysis of:
A variety of diagnostic tests may be used as well in order to evaluate vascular disorders.
Doppler or Ultrasound
A doppler or ultrasound examination may be used to analyze the blood flow in the arteries and veins.
Segmental Arterial Pressure and Pulse Volume Recordings
These help to assess the quality of blood flow in the vessels using small blood pressure cuffs and ultrasound transducers placed on the fingers and arm.
Magnetic Resonance Angiography
An MRI of the affected area is performed with special attention dedicated to the vessels (MRI/MRA).
Cold Stress Test
A cold stress test may be used to assess the severity and reversibility of vessel spasm. The temperature and blood pressure in the finger(s) are recorded before and after the hand is immersed in cold water.
Arteriography
Contrast is injected into the vessel, and X-rays are taken of the hand and arm. This is the most invasive test but also depicts the most detail of the vessels.
