Updated: 6/29/2021

Vascular Evaluation of the Hand

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Physical Exam
  • Radial pulse
  • Ulnar pulse
  • Capillary refill
  • Allen's test
    • Patient asked to open and clench both fists tightly repeatedly several times
    • Pressure is applied over radial arteries simultaneously to occlude
    • Patient then opens the fingers of both hands rapidly, and examiner compares the color of both. 
    • The initial pallor should be replaced quickly by rubor.
    • The test should then be repeated, this time occluding the ulnar arteries
Imaging
  • Three-phase bone scan
    • Phase I (2 minutes)
      • shows an extremity arteriogram
    • Phase II (5-10 minutes)
      • shows cellulits and synovial inflammation
    • Phase III (2-3 hours)
      • shows bone images
      • RSD diagnosed with positive phase III that does not correlate with positive Phase I and Phase II
    • Phase IV (24 hours)
      • can differentiate osteomyelitis from adjacent cellulitis
  • Duplex scan
    • is helpful for arterial intimal lesions (true and false aneurysms)
  • Arteriogram  
    • remains gold standard for embolic disease
    • downside is it is invasive with risks
  • Ultrasound duplex
    • imaging is becoming more sensitive and specific
  • Segmental limb pressures

 

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