Vascular Disorders of the Upper Extremity

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.

Common Causes of the Disorders

The causes of disorders to the vascular system can be sorted into five groups:

  • Disorders caused by trauma
  • Compressive disorders
  • Occlusive disorders
  • Vasospastic disorders, or spasms of the artery
  • 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.

Symptoms of Vascular Insufficiency

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.

Diagnosis & Examination

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.

Diagnostic Tests for the Disorder

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 

Causes of Vascular Disorders

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 an 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.