Vascular Conditions of the Hand

Overview

Most hand problems are orthopaedic or neurologic — a ligament, a nerve, a tendon. A smaller but important group of problems come from the blood vessels themselves. Recognizing that a symptom is vascular rather than neurologic is the first step toward the right treatment. This page covers the most common vascular conditions of the hand.

Raynaud's phenomenon

Raynaud's phenomenon is a reversible spasm of the small arteries in the fingers, triggered by cold exposure or emotional stress. It is common — up to 5% of the general population has some form of it.

• Symptoms: one or more fingers turn white (sometimes with a classic color sequence of white, then blue, then red) when exposed to cold or stress, often accompanied by numbness or burning pain. The attack resolves within minutes to an hour after warming up.
• Primary vs secondary. Most cases are primary Raynaud's, which is a benign exaggeration of the normal cold response and does not damage the fingers. A smaller number of cases are secondary to another disease (scleroderma, lupus, rheumatoid arthritis, certain medications, vibration exposure) and can cause ulcers or tissue loss. Distinguishing the two matters.
• Work-up: the key question is whether there are signs of an underlying autoimmune disease. Blood tests (ANA, inflammatory markers) and sometimes nailfold capillary examination by a rheumatologist help. A cold stress test with infrared imaging is occasionally used.
• Treatment: keep the whole body warm, not just the hands. Stop smoking. Avoid certain medications that provoke attacks (some over-the-counter decongestants, beta-blockers). Medications such as calcium channel blockers (nifedipine) are effective for more severe cases. Refractory cases may benefit from Botox injections into the palm or, rarely, a surgical procedure called a digital sympathectomy.

Hypothenar hammer syndrome

An injury to the ulnar artery in the palm, caused by repeated blunt trauma to the hypothenar region (the muscular pad at the base of the small finger). Typically seen in carpenters, mechanics, machinists, and people who use the palm as a hammer — hence the name.

• Symptoms: cold sensitivity in the small and ring fingers, color changes, a dull pain in the palm, and sometimes small ulcers on the fingertips. Symptoms are almost always one-sided, on the dominant hand.
• Mechanism: repeated trauma damages the wall of the ulnar artery where it crosses the hook of the hamate bone. The artery either goes into spasm, forms a clot, or develops an aneurysm. Small pieces of clot can break off and travel into the fingers, causing the color changes.
• Tests: Doppler ultrasound, CT angiography, or MR angiography to see the artery.
• Treatment: stop the repeated trauma (padded gloves, ergonomic changes). Blood thinners in selected cases. When there is an aneurysm or a segment of damaged artery, surgical repair — typically with a vein graft to restore the ulnar artery — is indicated.

Other vascular problems of the hand

• Digital artery aneurysms. Small aneurysms in the finger arteries, often after penetrating trauma or repetitive use. Present as a pulsating mass.
• Thrombosis of a digital or palmar artery. A sudden clot in one of the small hand arteries, causing a cold, painful, blue finger. Needs urgent evaluation.
• Vasospastic syndromes of the workplace. Repeated vibration exposure (jackhammers, chainsaws) can cause a Raynaud-like syndrome called hand-arm vibration syndrome (HAVS).
• Embolic disease. A clot from the heart, the shoulder, or a more proximal artery can lodge in a hand artery. This is a vascular emergency.

How vascular problems are diagnosed

• Exam. Comparing temperature, color, pulses, and capillary refill between fingers. An Allen test assesses flow through the radial and ulnar arteries.
• Doppler ultrasound. A fast, non-invasive way to look at flow in the hand arteries.
• CT or MR angiography. Provides a detailed map of the arteries, useful when surgical repair is being considered.
• Catheter angiography. Used when a therapeutic intervention (such as dissolving a clot) may be performed at the same time.
• Referral to rheumatology for suspected secondary Raynaud's or other autoimmune disease.

Treatment options

Non-surgical treatment

• Avoid cold exposure; warm the whole body, not just the hands
• Stop smoking and nicotine (including vaping) — nicotine is a potent vasoconstrictor
• Adjust or stop medications that worsen symptoms
• Calcium channel blockers (nifedipine) for Raynaud's
• Aspirin or other blood thinners in selected cases
• Botox injections in the palm for refractory Raynaud's or digital ischemia
• Ergonomic changes and padded gloves for hypothenar hammer

Surgical treatment

• Ulnar artery reconstruction for hypothenar hammer syndrome — typically with a vein graft
• Digital sympathectomy — stripping the sympathetic nerve fibers off the digital arteries to reduce spasm; used in severe, refractory ischemia with tissue loss
• Revascularization of an acutely occluded artery
• Aneurysm resection and repair

What to expect at your visit

Dr. Barrera will examine the hand, check pulses, perform an Allen test, and order imaging when appropriate. Many vascular problems of the hand are managed medically; the role of a hand surgeon is to identify the small number that need a targeted operation and to coordinate with vascular medicine and rheumatology when those specialties are needed.

Questions?

Call your office location for non-urgent questions:

• NYU Langone Laurelton · 646-501-4950
• NYU Orthopedic, Woodside · 929-429-3222
• NYU Orthopedic, Richmond Hill · 718-206-6923
• Jamaica Hospital Ambulatory Care Center (ACC) · 718-301-0720

See our office contact information for addresses and fax numbers.