Raynaud’s Syndrome has cropped up on 4 occasions in my clinic since April, which is most unusual as we do not often see a true Raynauld’s patient in The Physiotherapy Centre, most likely because we have a warm and temperate climate here in Mallorca.
Actually none of my patients suffered from Raynaud’s. Each patient has been considered to have Raynaud´s as part of a differential diagnostic. In other words, the problem presented as Raynauld’s but the symptoms were in fact caused by something completely different.
Raynaud´s Phenomenon or Syndrome is when the blood vessels to your hands or feet tighten up in a spasm which temporarily causes a diminished blood supply to your fingers or toes which then turn very pale with the lack of oxygenated blood flow. Other body parts can also suffer this problem including the toes, nipples, ears and nose but it is usually the extremities which experience cold, numbness and/or tingling sensations.
Using the example of the digits, Initially the fingers or toes become white (aka pallor) due to the lack of blood supply to the area. They may then turn bluey black (aka cyanosis) as the blood vessels open up to allow a greater flow into the area, then they again change colour to a pinky red (aka rubor) as the blood flow returns.
This is a very startling phenomenon and particularly distressing the first time it occurs however Raynauds´s is not a life threatening disease and can be controlled by the sufferer with simply keeping the affected body parts warm in cold weather.
What is a Differential Diagnosis ?
A practitioners job is of course to correctly diagnose the patient´s problem, however many times it is equally important to know what the problem is not in order to arrive at a correct diagnosis. This may sometimes require the patient to have a frustrating array of tests which will often come out negative and yet they are just as important as the positive findings.
Raynaud´s Phenomenon Differential Diagnosis
Raynauld´s can present as many other conditions;
Anatomical Anomalies such as Carpal Tunnel Syndrome and Thoracic Outlet Syndrome.
Circulatory Disorders such as Peripheral Vascular Disease, Vasculitis or Chillblains.
Blood Related Problems such as Systemic Lupus Erythematosis, Lymphoma, Scleroderma, Vibration Injury and Leukemia.
Drug Regimes and Drug Abuse may also be added such as Beta Blockers, Contraceptives and Cocaine.
This is only a short list of possibilities.
Who To See
If you think you are suffering from Raynauld´s syndrome, as already mentioned, it may well be necessary to see more than one specialist and undergo several medical tests which will certainly include blood tests to check for autoimmune disorders and blood anomalies. EMG (electromyogram) to check if there is any neurological deficit and an MRI (magnetic resonance scan) may also be required for the differential diagnosis.
The Specialists may well include the disciplines of Orthopaedics, Rheumatology, Neurology and Vascular Consultants.
Further information and advise can be found on the UK National Health website. www.sruk.co.uk
Tracey Evans – The Physiotherapy Centre
email@example.com – +34 609 353 805