Raynaud’s - Not All Created Equal
Joann Lohr1, Michael Gibbons1, Anil Verma2, Fonda Wilkins1.
1William Jennings Bryan Dorn VA Medical Center, Columbia, SC, USA, 2Mercy Health, Cincinnati, OH, USA.
OBJECTIVES: The medical community especially urgent care center and emergency room providers need to have an increased awareness of the severity and potentially limb threatening issues that can present as underlying vague hand complaints or long standing non-healing wounds of the digit or hand.
METHODS: Retrospective chart review was performed on twelve patients who presented for evaluation of “blue fingers” and had variable pain, neurologic symptoms or non-healing wounds.
RESULTS: All twelve were seen in an emergency room or urgent care center, discharged (3 on antibiotics) and referred for routine outpatient followup with primary care, orthopedics or vascular surgery. All were seen a minimum of twice, while seven were seen more than four times in various emergency centers before more aggressive evaluation and treatment was under taken. One patient was on Tamoxifen for breast cancer, eight were current smokers, one had an undiagnosed connective tissue disorder(CREST), three were on dialysis, six were diabetic. Ages ranged from 18 to 63 years. Seventy five percent were females. All were reported to have “ palpable pulses “ ,but on arterial duplex evaluation and digital PPG examination all had abnormalities. Lytic therapy restored flow in four patients, arterial bypass was required in two, fistula banding in one, arterial stenting in six. Three patients had amputations. An underlying undiagnosed thrombophilic defect was identified in eight which are on lifelong anticoagulation.
CONCLUSIONS: Vague ischemic hand symptoms need to be aggressively evaluated and treated with a sense of urgency to decrease the risk of loss of function or tissue. Imaging is mandatory. Women especially may have an associated undiagnosed issue which may result in rapid progression. These patients need urgent vascular evaluation not referral for routine evaluation in 6-8 weeks. Emergency room presentation of hand symptoms should be considered a harbinger of a potential more serious underlying problem. Both obstructive and vasospastic etiologies need to be considered.
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