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Raynaud's Phenomenon: An Array of Possible Causes

Raynaud's Phenomenon: An Array of Possible Causes

FigureDrs Sonia Arunabh and K. Rauhilla's case of a 62-year-old woman with Raynaud's phenomenon (CONSULTANT, September 15, 2001, page 1526) offers one of the finest photographs of this condition that I have seen (Figure). The patient had hypertension and diabetes mellitus, and she had been a heavy smoker for many years. Rheumatologic and endocrine workups were negative. Primary Raynaud's phenomenon was diagnosed, and a calcium channel blocker was prescribed, which ameliorated the patient's symptoms.

In their case report, however, the authors did not discuss what appears to be marked thenar atrophy or the patient's extremely tight rings. The transverse markings on the volar aspect of the wrist are also of interest—or perhaps they are only skin creases.

Median nerve compression and carpal tunnel syndrome may be the cause of her muscle wasting. Were an electromyelogram and a nerve conduction study done?

Also, what were the results of her most recent thyroid evaluation? Hypothyroidism can cause both carpal tunnel syndrome and Raynaud's phenomenon. Finally, I hope the patient was advised to remove her tight-fitting rings. — Robert A. Scalice, MD
    Gloucester, Mass

You are certainly an astute clinician! Results of the patient's thyroid function tests were normal, and she has been advised about the rings before. We had postponed doing an electromyelogram and nerve conduction study while treating the Raynaud's phenomenon. However, since this case study appeared, nerve conduction studies have been performed. These did not reveal carpal tunnel syndrome; nonetheless, the patient feels better using splints on her hands.

— Sonia Arunabh, MD
    New Hyde Park, NY

 
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