Conservative Management of Raynaud's Disease

By R. Vincent Davis, DC, PT, DNBPM
Raynaud's disease is a condition of recurring episodes of angiospasm of peripheral arteries, predominantly the arterioles. This angiospastic disorder presents clinically in a symmetrical pattern affecting the upper extremities and is commonly seen in females. Unlike Raynaud's phenomenon, in which an etiological source is diagnostically identifiable, this condition is idiopathic in character.

Common clinical features involve angiospasm of the arterioles of the digital arterial trees due to the effects of an exciting stimulus which are frequently cold temperature and/or emotional stress. Arterial doppler studies and/or arteriograms will assist in ruling out occlusive disease and this disease may be confirmed by exposure of the reactive part to cold temperature to demonstrate the integumental color changes. Initially there is pallor due to vasospasm with the absence of the hunting reflex (as described by Sir Thomas Lewis) which would commonly follow a short period of pallor. Subsequently, the capillaries and venules become fully dilated with venule to capillary reflux and resulting cyanosis due to blood stagnation. In advanced histories their may be ulcerations and necrosis at the fingertips due to intimal thickening and thrombo-occlusive disorder.

Treatment, especially in the initial history, involves patient instruction in prophylaxis by avoiding the source stimulus. Mecholyl pulsed phonophoresis may be effective, but care must be exercised in its administration to avoid flushing, perspiring, salivation, tachycardia, hyperperistalsis, and hypotension which are systemic effects that are undesirable. Mecholyl vasodilation may last for six to eight hours using a 0.2 percent solution. Smoking is prohibited. Occasionally, the simple act of warming the hands and the body is an effective way of aborting an episode. The treating physician is reminded that thermal agents must be applied to the body in such a manner that heat is dissipated by the tissues at a rate equal to or faster than the rate at which is generated in order to avoid thermal tissue injury.

Vascular tumors, such as subungal glomus tumor and other organic etiologies, must be ruled out as a nidus of angiospasm to render a diagnosis of Raynaud's disease. Raynaud's phenomenon should properly be referred to the appropriate specialty for correct evaluation and treatment if suspected or known to be present clinically.

References

Anderson WAD. Pathology, 3rd ed. Mosby.

Davis FA. Soft Tissue Pain & Disability, Cailliet Series.

Davis RV. Therapeutic Modalities for the Clinical Health Sciences, 2nd ed. Library of Congress Card TXU-389-661, 1989.

Griffin JE and Karselis TC. Physical Agents for Physical Therapists, 2nd ed. Springfield: Charles C. Thomas Publishers, 1982.

Krusen, Kottke, Ellwood. Handbook of Physical Medicine & Rehabilitation, 2nd ed. Philadelphia: W.B. Saunders Company, 1971.

Schriber WA. A Manual of Electrotherapy, 4th ed. Philadelphia: Lea & Feibiger, 1975.

Zoethout and Tuttle. Physiology, 12th ed. Mosby.

R. Vincent Davis, DC, BSPT, DNBPME
Independence, Missouri



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