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Pathogenesis

1. Overactive alpha receptors causing vasoconstriction or
2. Fixed obstruction in vessel wall which reduces distal flow

Classification

1. Primary
   • Vasomotor vasospasm
2. Secondary
   • Pathology affecting vessel wall
   • Blood disorders - polycythaemia
   • Atherosclerosis, thromboangiitis oliterans
   • Drugs - B-blockers, OCP
   • CT: Rheumatoid arthritis, SLE, scleroderma, PNA
   • Trauma: vibration injury

Approach

• Expose hands

1. Inspection
   
   • Usually bilateral
   • Skin may be red and dry, especially around tips of fingers and the nails brittle

     WBC

     White: blanching of digits
     B: blue cyanosis and pain
     C: Crimson: reactive hyperaemia - fingers turn red in colour

   • Note any ulcers or gangrene on the pulps
2. Palpation
   • Radial pulse normal

Treatment options

1. Non-surgical
   • Use of gloves to warm hands
   • Avoid predisposing factors
   • Encourage to stop smoking
2. Medical
   • Calcium channel blockers - Nifedipine
   • Prostacylin analoguse
   • Alpha blockers
   • 5HT antagonists
3. Surgical
   • Cervical sympathectomy and amputation (if threatened by gangrene)