history and examination
Last reviewed 05/2021
Raynaud's phenomenon is diagnosed clinically and requires that a number of points be covered during the history and examination:
In the history:
- classical triphasic changes in the colour of the extremities, inquire about
- the frequency and pattern of colour changes and at which stage(s) they experience
- not all of the three phases are needed to make a diagnosis
- an attack may last for minutes to hours.
- which digits are affected
- associated features such as pain and changes in sensation
- patients may complain of tightness in the first two stages and burning pain in the reperfusion stage.
- what triggers an attack e.g. - drug exposure (beta-blockers, oral contraceptives), use of vibrating machinery, work in cold environment (fishing industry)
- what relieves it
- a systemic inquiry to identify secondary causes
- any evidence of a rash, photosensitivity, migraines, joint pains, ulcers, dysphagia, and xerostomia.
- drug treatment history (such as betablockers)
- occupational history (such as use of a vibratory tool)
- family history (to check for genetic components to both primary Raynaud phenomenon and systemic sclerosis) (1,2)
On examination:
Focus of examination may vary according to the clues from the history
- hands
- look for colour changes, nail bed changes, and skin integrity.
- sclerodactyly, flexion deformities, tendon friction rubs and calcinosis are present in systemic sclerosis
- digital ulceration if present indicate secondary cause
- feel for limb pulses
- move all joints and assess for pain and contracture
- face
- malar rash, non-scarring alopecia, and oral ulcers suggesting systemic lupus erythematous,
- tightening of the skin seen in systemic sclerosis
- dry skin, telangiectasia, and the salt and pepper appearance of hyperpigmentation and hypopigmentation, which are indicative of systemic sclerosis.
- livedo reticularis, suggesting systemic lupus erythematous or antiphospholipid syndrome
- measure blood pressure in both arms: possible obstructive vascular lesion in the subclavian or axillary arteries
- note that a unilateral Raynaud's phenomenon affects a single limb when there is local pathology e.g. Raynaud's phenomenon in only a single foot may be secondary to a popliteal aneurysm (1,2)
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