Atrium Health Navicent Heart & Vascular Care

Upper Extremities Disorders

Illustration of a human body in distress from an Upper Extremity Disorder

Upper extremities disorders are not nearly as common as disorders of the lower extremities, but they still affect around 10% of people. Not every upper extremities disorder can be cured. Some types of disorders can be cured, while others can only be managed.

Anatomy and Upper Extremities Disorders

The vascular system is incredibly important - it delivers nutrients, gets rid of metabolic waste, and maintains core temperature. Arteries transport blood from the heart to the tips of your fingers. The veins then take the used blood to the lungs and the heart. The flow of the vascular system is controlled by a number of things, like vessel anatomy and metabolic requirements of organs. When the vascular system does not work efficiency, it can lead to problems like upper extremities disorders.

Causes of Upper Extremities Disorders

There are multiple reasons why a person may have vascular problems, including:

  • Acute trauma
  • Systemic diseases
  • Repetitive microtrauma
  • Other chronic conditions

Causes can be split up into five groups:

  1. Traumatic
  2. Occlusive
  3. Compressive
  4. Vasospastic
  5. Tumors and malformations

It is common for a person who already has a disease like kidney failure or diabetes to have vascular problems. When a person's occupation exposes them to certain elements, such as extreme cold or vibration, this can cause vascular problems as well. Smoking can also cause or aggravate upper extremities disorders.

Four Common Causes of Upper Extremities Disorders

1. Raynaud's Disease

Raynaud's Disease is when the fingers' arteries spasm, which blocks blood flow. The fingers will change color, first becoming white and then changing to blue. When the spasm is over and the blood flow is back to normal, the fingertips will go back to red. Spasms will occur if the hand is exposed to tobacco or cold. To treat Raynaud's Disease, patients are advised to quit smoking, stay out of cold weather and wear gloves. Certain medicines may also be prescribed to improve blood flow. However, if the body does not respond to any of these measures, surgery may be necessary.

2. Trauma

A knife wound or other type of penetration that causes trauma can result in a vascular disorder because it damages blood vessels. Even a small cut that does not cause alarm can result in serious damage. Blunt injuries can also bruise blood vessels to the point of causing a blood stop or inhibiting blood flow to the fingertips. If this happens, the fingertips can turn white and be cold and painful. When blood flow stops, reconstruction is often needed immediately. Sometimes, though, traumatic injuries may not severely affect the upper extremities because there are arteries that are able to still provide blood flow.

3. Malformations

If there is a malformation between the arteries and veins, extra blood goes through the vessels, which can enlarge them. Symptoms include pain, heaviness, hair growth, an increase in temperature, sweating and bleeding. If this is caught when it's still small, a compression glove can be the solution. If the malformation is large, though, surgery may be needed.

4. Aneurysm

When a vessel wall is weakened, the vessel can expand. The vessel may have a soft mass over it. Often, there is no pain associated with a weakened vessel wall and resulting mass. A blood clot can then block the vessel. Sometimes, small clots on the fingertips will appear. If there is an aneurysm in the wrist, patients may notice intolerance to cold, numbness, pain or enlargement. Gangrene can also occur.

Symptoms of Upper Extremities Disorders

  • Dysesthesias
  • Pain
  • Intolerance to cold
  • Changes in the color of fingertips
  • Paresthesias
  • Ulceration that doesn't heal
  • Pallor
  • Tingling or numbness of fingertips
  • Swelling

When a doctor examines a patient for upper extremities disorders, they will look for the following:

  • Pulse quality in the elbow, wrist, finger or armpit
  • Distension of the veins
  • Gangrene or ulceration of the fingertips
  • Swelling
  • Discoloration
  • Temperature
  • Masses, noting their color, size, and location

Evaluation of Upper Extremities Disorders

In order to evaluate upper extremities disorders, several tests should be done. An ultrasound machine or Doppler can evaluate how the blood is flowing in the veins and arteries. Recordings of the pulse volume can assess the blood quality. An MRI can show the health of the vessels. A cold stress test can assess spasms of the vessels. Lastly, arteriography can be used to evaluate a vascular disorder by taking X-rays of the arm and hand.