Physical Exam Findings in Raynaud's Phenomenon

Introduction to Raynaud's Phenomenon

The American Geriatrics Society recommends that the physical examination in primary Raynaud's phenomenon is typically unremarkable between attacks, while secondary Raynaud's may reveal signs of underlying connective tissue disease, digital ulcers, or tissue necrosis 1

The entire hand may be involved rather than just isolated digits in secondary Raynaud's, according to Praxis Medical Insights 2
Physical examination is usually unremarkable in primary Raynaud's phenomenon, with no digital ulcers, tissue necrosis, or gangrene present, as stated by the American Geriatrics Society 1
No signs of underlying connective tissue disease are present in primary Raynaud's phenomenon, according to the American Geriatrics Society 1

Digital ulcers are present in 22.5% of patients with systemic sclerosis-associated Raynaud's, as reported by Praxis Medical Insights 2
Tissue necrosis or gangrene occurs in 11% of systemic sclerosis patients, according to Praxis Medical Insights 2
Digital pitting scars from healed ulcers are a common finding, as stated by Praxis Medical Insights 3

Skin thickening or tightness, such as sclerodactyly in systemic sclerosis, is a significant finding, according to Praxis Medical Insights 3
Telangiectasias, calcinosis cutis, and photosensitive rash are other skin findings that suggest connective tissue disease, as reported by Praxis Medical Insights 3, 2

Abnormal or absent peripheral pulses suggesting atherosclerosis or thromboangiitis obliterans are a significant finding, according to Praxis Medical Insights 3

Peripheral neuropathy on neurologic examination is a common finding, as stated by the American Geriatrics Society 1
Radiculopathy findings suggest secondary causes requiring further workup, according to the American Geriatrics Society 1

Joint swelling or deformities, such as those suggesting rheumatoid arthritis, are a significant finding, according to Praxis Medical Insights 3, 2
Muscle weakness and synovitis are other musculoskeletal findings that suggest connective tissue disease, as reported by Praxis Medical Insights 2, 3

The American Geriatrics Society recommends that one should not assume primary Raynaud's without a thorough examination, as missing secondary causes can lead to delayed diagnosis and poor outcomes, including digital ulcers 1
Always perform a complete neurologic examination to identify peripheral neuropathy or radiculopathy as secondary causes, as stated by the American Geriatrics Society 1
Look carefully for subtle signs of connective tissue disease, including skin changes, joint findings, and systemic symptoms, as recommended by Praxis Medical Insights 3, 2
Examine all digits carefully for ulcers or scars, as digital complications are the most serious manifestation requiring aggressive treatment, according to Praxis Medical Insights 3, 2