Hand surgeon Ekkehard Bonatz, MD, PhD answers your questions about Raynaud’s disease, Raynaud’s phenomenon, and the difference between the two.
What is Raynaud’s?
Raynaud’s is known as Raynaud’s disease, Raynaud’s phenomenon and Raynaud’s syndrome. It is a medical condition in which the circulation to your fingertips is interrupted. The fingers, and sometimes toes, will turn pale and white as they have no blood supply. After a while they turn blue, and you may experience discomfort or pain. Eventually the blood flow to the fingers returns, making them appear red, and your fingers may burn. The problem then settles down, with return of normal circulation and feeling, and the burning disappears. The periods of discoloration may last from a few minutes to several hours.
What are the two forms of Raynaud’s?
Raynaud’s disease, also known as primary Raynaud’s, is the most common form when the blood vessels in your fingers react to stress and shut down the circulation to the fingertips. This can be also caused by low temperatures. It is more common in women. It is unclear what exactly causes the episodes of cold and white fingers. Usually there is no long-term damage to the tips of your fingers or toes.
Raynaud’s syndrome, also known as Raynaud’s phenomenon or secondary Raynaud’s, is the result of another disease affecting your blood vessels. It is most commonly seen in patients with lupus or rheumatoid arthritis. It is more serious and can lead to sores on the fingertips or areas of dead skin (gangrene).
How is Raynaud’s diagnosed?
There is a typical order of skin discoloration in the fingers: first they are pale and white, then blue, and finally bright red or scarlet red, as the circulation returns. Your physician will ask about any history regarding stress factors on your life and whether there may be a history of rheumatoid arthritis or lupus. Blood tests can often determine if you are at risk for these problems. A skin doctor (dermatologist) can look at your fingernails with a special magnifying glass to detect any abnormal blood vessels in your nail bed.
What causes Raynaud’s?
Raynaud’s disease: We do not know what exactly causes Raynaud’s disease. Stress of any kind, such as emotional stress, or cooler temperatures around your fingers (even while washing your hands) can cause the small blood vessels in your hands to clamp down and make your fingers hurt. Carpal tunnel syndrome, some medications to treat high blood pressure, and cancer drugs can be associated with Raynaud’s disease.
Raynaud’s phenomenon / Raynaud’s syndrome: Permanent changes in the lining of the small blood vessels of your hands and fingers will hinder the blood vessels from carrying sufficient circulation to the fingertips. These changes are often seen in rheumatoid arthritis, scleroderma, lupus, or other diseases affecting the soft tissues of your joints. They are also present in your heart and brain. Smoking causes blood vessels to constrict, and you should stop smoking regardless of the type of Raynaud’s!
How is Raynaud’s treated?
Raynaud’s disease often needs just simple measures to keep your fingers warm and to keep stress to a minimum. Regular physical exercise can decrease stress. Wearing gloves in cooler weather helps. Avoid cold medicines containing pseudoepiphedrine. Your physician may prescribe medications to take to dilate the small blood vessels in your fingers. He or she may also offer ointments with a similar effect.
Raynaud’s phenomenon/Raynaud’s disease can be treated with medications or creams. There are injections which can help to restore some of the circulation in the fingertips. As a last resort your hand surgeon might also discuss stripping the outside lining of blood vessels in the hand and wrist so as to allow them to carry more blood again to the fingertips.
What can I expect in the long term?
Raynaud’s disease is usually benign, and you can rest assured that permanent soft-tissue damage is unlikely.
Raynaud’s phenomenon/Raynaud’s disease requires close medical follow up. Impaired circulation in your fingertips is painful, can lead to infection and gangrene, and may even require amputation. Any disease in those small blood vessels is also present in your brain and in your heart and puts you at risk for strokes and heart attacks. Close medical treatment by a physician is therefore imperative.
If you’re experiencing symptoms of Raynaud’s, visit a hand surgeon to discuss the best treatment options for you. Find a hand surgeon near you.
Ekkehard Bonatz, M.D., Ph.D., is a partner at Southlake Orthopaedics in Birmingham and Hoover, AL. He specializes in hand and upper extremity surgery. He is also a faculty member of the hand and upper extremity fellowship program at the University of Alabama at Birmingham. His surgical training was at the Baptist Medical Centers in Birmingham and at UAB, where he completed his orthopaedic surgery training. He subsequently trained in hand and upper extremity, microsurgery, and reconstructive surgery at UAB.