history and examination

Last reviewed 05/2021

Raynaud's phenomenon is diagnosed clinically and requires that a number of points be covered during the history and examination:

In the history:

  • classical triphasic changes in the colour of the extremities, inquire about
    • the frequency and pattern of colour changes and at which stage(s) they experience
      • not all of the three phases are needed to make a diagnosis
      • an attack may last for minutes to hours. 
    • which digits are affected
    • associated features such as pain and changes in sensation
      • patients may complain of tightness in the first two stages and burning pain in the reperfusion stage.
    • what triggers an attack e.g. - drug exposure (beta-blockers, oral contraceptives), use of vibrating machinery, work in cold environment (fishing industry)
    • what relieves it
  • a systemic inquiry to identify secondary causes
    • any evidence of a rash, photosensitivity, migraines, joint pains, ulcers, dysphagia, and xerostomia.
    • drug treatment history (such as beta­blockers)
    • occupational history (such as use of a vibratory tool)
    • family history (to check for genetic components to both primary Raynaud phenomenon and systemic sclerosis) (1,2)

On examination:

Focus of examination may vary according to the clues from the history 

  • hands
    • look for colour changes, nail bed changes, and skin integrity. 
    • sclerodactyly, flexion deformities, tendon friction rubs and calcinosis are present in systemic sclerosis
    • digital ulceration if present indicate secondary cause
  • feel for limb pulses
  • move all joints and assess for pain and contracture
  • face
    • malar rash, non-scarring alopecia, and oral ulcers suggesting  systemic lupus erythematous,
    • tightening of the skin seen in systemic sclerosis
  • dry skin, telangiectasia, and the salt and pepper appearance of hyperpigmentation and hypopigmentation, which are indicative of systemic sclerosis.
  • livedo reticularis, suggesting systemic lupus erythematous or antiphospholipid syndrome
  • measure blood pressure in both arms: possible obstructive vascular lesion in the subclavian or axillary arteries
  • note that a unilateral Raynaud's phenomenon affects a single limb when there is local pathology e.g. Raynaud's phenomenon in only a single foot may be secondary to a popliteal aneurysm (1,2)

Reference: