Introduction Raynaud's is an exaggerated vasocontriction of the digital arteries in response to a variety of stimuli. It takes two forms Raynaud's Phenomenon or Raynaud's Syndrome vasospastic disease with a known underlying cause Raynaud's Disease vasospastic disease with no known cause (idiopathic) Etiology Pathophysiology periodic digital ischemia due vasoconstriction induced by cold temperature or sympathetic stimuli including pain or emotional stress triphasic color change (white-blue-red progression) digits turn white from vasospasm and interruption of blood flow blue discoloration follows from cyanosis and venous stasis finally digits turn red as a result of rebound hyperemia dysesthesias often follow color changes Raynaud's Phenomenon Vasospastic disease with a known underlying disease epidemiology demographics login to view 2 more bullets location login to view 1 more bullet associated conditions connective tissue disease login to view 7 more bullets Presentation Symptoms asymmetric findings rapid progression Physical exam peripheral pulses often absent frequent trophic skin changes (including ulceration and gangrene) abnormal Allen test Studies labs blood chemistry - often abnormal invasive studies microangiology - often abnormal angiography - often abnormal Imaging radiographs normal and not indicated Raynaud's Disease Vasospastic disease with no known cause (idiopathic) epidemiology seen in young premenopausal women (age <40 years) Presentation symptoms often bilateral slow progression Allen and Brown Criteria for Raynaud's Disease Intermittent attacks with discoloration of acral parts Bilateral involvement Absence of clinical arterial occlusion Gangrene and trophic changes are rare Symptoms present for >2 years Predominance in women Absence of other disease to explain findings physical exam peripheral pulses usually present trophic skin changes are uncommon normal Allen test Imaging radiographs normal and not indicated Studies labs usually normal invasive studies usually normal diagnosis based on Allen and Brown criteria Differential Factors to differentiate Raynaud's Phenomenon or Raynaud's Disease age gender time frame of symptom progression severity of exam findings Treatment Nonoperative medical management & lifestyle modifications indications login to view 1 more bullet modalities login to view 10 more bullets Botulinum toxin A injections indications login to view 4 more bullets contraindications login to view 4 more bullets Shown to improve digital perfusion Operative thorascopic sympathectomy indications login to view 1 more bullet digital sympathectomy indications login to view 5 more bullets microvascular reconstruction indications login to view 1 more bullet Complications digital ischemia leading to ulcerations and/or gangrene may necessitate amputation of digit(s)