Raynaud's Phenomenon: An Array of Possible Causes

Drs Sonia Arunabh and K. Rauhilla's case of a 62-year-old woman with Raynaud'sphenomenon (CONSULTANT, September 15, 2001, page 1526) offers one ofthe finest photographs of this condition that I have seen (Figure). The patient hadhypertension and diabetes mellitus, and she had been a heavy smoker for manyyears. Rheumatologic and endocrine workups were negative. Primary Raynaud'sphenomenon was diagnosed, and a calcium channel blocker was prescribed, whichameliorated the patient's symptoms.

In their case report, however, the authors did not discuss what appears to bemarked thenar atrophy or the patient's extremely tight rings. The transverse markingson the volar aspect of the wrist are also of interest-or perhaps they are onlyskin creases.

Median nerve compression and carpal tunnel syndrome may be the cause ofher muscle wasting. Were an electromyelogram and a nerve conduction study done?

Also, what were the results of her most recent thyroid evaluation? Hypothyroidismcan cause both carpal tunnel syndrome and Raynaud's phenomenon.Finally, I hope the patient was advised to remove her tight-fitting rings.

- Robert A. Scalice, MD
    Gloucester, Mass

You are certainly an astuteclinician! Results of thepatient's thyroid functiontests were normal, and shehas been advised aboutthe rings before. We had postponeddoing an electromyelogram andnerve conduction study while treatingthe Raynaud's phenomenon. However,since this case study appeared,nerve conduction studies have beenperformed. These did not revealcarpal tunnel syndrome; nonetheless,the patient feels better usingsplints on her hands.

- Sonia Arunabh, MD
    New Hyde Park, NY