A patient, aged 68 years, presented with a slow-growing, painful mass on her left middle finger. The mass had been present for one year. The patient reported significant pain to the touch but no pain at rest. The patient’s past medical history included Raynaud’s disease and vasculitis.
On exam, a solid, immobile mass was found at the distal aspect of the finger.
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Raynaud’s disease is an idiopathic vasospastic disease that can interrupt blood flow to the fingers, toes, nose, and/or ears. Vasospasm can result from cold temperature, pain, or emotional response that causes sympathetic stimuli.
Fingers may turn white as blood flow is interrupted, followed by blue discoloration as a result of cyanosis and venous stasis, and then red as a result of re-perfusion. Raynaud’s is nine times more likely in women and can be associated with scleroderma, lupus, and rheumatoid arthritis.
Although there is no cure for Raynaud’s, symptoms can be treated. Treatments include smoking cessation, medications such as including calcium channel blockers and blood thinners, and digital sympathectomy.
In rare cases of severe Raynaud’s disease, poor perfusion may result in tissue death and skin breakdown of the fingers. Left untreated, the tissue death may result in dry gangrene.
Dry gangrene usually starts as an ulcer and becomes painful as the tissue dies. The affected tissue changes from red to brown to black. The dry gangrene may shrivel up, separate from healthy tissue, and fall off over time.
Dagan Cloutier, MPAS, PA-C, practices in a multispeciality orthopedic group in the southern New Hampshire region and is editor in chief of the Journal of Orthopedics for Physician Assistants (JOPA).
- Raynaud’s Association. (2015). Retrieved from http://www.raynauds.org/
- Allen D. (2013, April 13). Raynaud’s Syndrome. Retrieved from http://www.orthobullets.com/hand/6098/raynauds-syndrome
All electronic resources were accessed on April 9, 2015.