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Beverly Hills
9301 Wilshire Boulevard
Beverly Hills, California 90210
Wilmington
123 F St., Suite G
Wilmington, California 90744
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INSURANCE & WORKERS' COMPENSATION
ACCEPTED!
We accept most types of insurance
providers and specialize in the treatment of workers'
compensation injuries to the hand and upper extremity. |
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Vascular Disorders of the Upper Extremity
Common Causes of the Disorder
Symptoms of Vascular Insufficiency
Diagnosis & Examination
Diagnostic Tests for the Disorder
Causes of Vascular Disorders
Blood filled with oxygen is carried from the heart by arteries and
returned to the heart and lungs by veins. There are two major arteries
in the wrist that bring blood to the hand, but because of personal
differences, not everyone's anatomy is exactly the same. The way blood
gets to the fingers is often different across individuals.
Many things can impact the flow of blood and the vascular system.
Although disorders to the upper-extremities (i.e., the area from the
arms to the fingertips) aren't particularly common, any that arise
can impact health in significant and long-lasting ways.
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| Common Causes of the Disorders |
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The causes of disorders to the vascular system can be sorted into
five groups:
1. Disorders caused by trauma
2. Compressive disorders
3. Occlusive disorders
4. Vasospastic disorders, or spasms of the artery
5. Tumors and malformations
Those with certain diseases such as kidney failure, diabetes, or hypertension
often have vascular disorders, as do those who undergo dialysis. Smoking
and some occupational contexts, such as working in cold temperatures
or with vibrating equipment, are also associated with vascular problems.
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| Symptoms of Vascular Insufficiency |
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An impaired supply of blood can produce a number of symptoms. Any
of these may indicate that a visit to your hand surgeon should be
considered. Any changes in the color of the fingertips, or any sense
of numbness or tingling in them, can indicate a loss of blood circulation.
Fingers, or the entire hand, may be more susceptible to cold, which
may be hard to relieve and tolerate. Areas around the blood vessels
may become swollen, and ulcers or sores on the hand may be slow to
heal, if they heal at all.
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| Diagnosis & Examination |
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Your hand surgeon will examine you, especially your extremities, if
vascular insufficiency is suspected. During the examination, your
pulse and its strength will be checked by your hand surgeon in a number
of locations. Such locations include the armpit, elbow, wrist, and
at the finger. Your surgeon will also examine you for signs of swelling
or vein distension and discoloration. Your hand surgeon will take
your temperature and your fingertips will be carefully checked for
the possibility of gangrene or signs of ulcers. Any masses or lumps
will be examined to determine their size, color, character, location,
and you will be asked about their duration.
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| Diagnostic Tests for the Disorder |
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If earlier examinations support it, many diagnostic tests to confirm
the diagnosis and evaluate the extent of the disorder may be used.
Such tests include:
Checking the blood flow in the arteries and veins through ultrasound
or Doppler examinations
Using small cuffs and ultrasound transducers on the fingers and
arm to record the pressure in the arteries and the volume of blood
carried by the veins each pulse
Taking an MRI or magnetic resonance angiography (MRA) of the affected
area to examine the vessels
Injecting contrast into the blood vessel suspected to have a problem
and taking an x-ray of the hand or arm in a procedure called arteriography,
which gives the most detailed view of the system
Doing a cold stress test, where the finger's blood pressures and
temperatures are measured before and after they've been held in
cold water. This test will check how much the blood vessels react
and how quickly they return to normal
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| Causes of Vascular Disorders |
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Many things can injure a blood vessel and impair its use, including:
Vascular Malformation - This condition presents itself when
the connection between the veins and arteries is unusual. Typically,
the tiny vessels connecting them are forced to carry much more blood
than usual and grow in size. Any time the small vessels connecting
veins and arteries have to carry abnormally large amounts of blood,
the area affected can produce pain and show a higher temperature
than surrounding areas. It's also common for the area to show localized
sweating and hair growth, and spontaneous and unexpected bleeding
may occur.
Aneurysms - If a portion of a vein or arterial wall is weak,
it can suddenly expand and pop. This condition is referred to as
an aneurysm. It is usually painless, but a mass might show up where
it occurred. After the vessel pops, it may become blocked if a clot
forms. If the aneurysm is in the wrist, it can lead to pain or numbness,
an increased sensitivity to pain, and even gangrene at the fingertips.
Raynaud's Disease - This phenomenon occurs when the arteries
in the fingers begin to spasm and cut off the flow of blood. When
this happens, the fingers, themselves, often lose color and become
whiter, only to get their original color back when the spasm ends.
The spasms often show up after the hand is exposed to tobacco or
cold, so treatment includes quitting smoking and protecting the
hands from the cold by wearing gloves or mittens. Medicine, also,
can be helpful in treating the condition by improving the flow of
blood to the fingertips by expanding the blood vessels. If these
treatments don't work, surgery to separate the nerves around the
vessels can be performed to attempt to reduce their contribution
to the spasms.
Trauma - Obviously, any cut from a sharp object can damage
the blood vessels, but they can be injured by blunt objects as well.
Small cuts that seem harmless can cause major damage, and whenever
a blood vessel is injured a clot can form stopping the flow of blood
from reaching the fingertips. When this happens, the fingertips
will lose their color and grow cold and painful. Unless your hand
surgeon is certain that other arteries can keep supplying blood,
reconstructing or repairing the vessel may be necessary to prevent
gangrene and death of the finger.
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