Vascular Disorders of the Hand

Vascular disorders of the hand and upper extremity encompass a wide range of conditions that can cause peripheral ischemia. These can be purely mechanical in nature, secondary to trauma. They can also be the culmination of multiple systemic diseases, including peripheral arterial disease, end-stage renal disease, and a variety of connective tissue disorders. Key to the successful management of ischemia of the hand and upper extremity is a clear diagnosis. It is only then that the appropriate treatment algorithm can be employed. This review provides an overview of the relevant anatomy and key aspects of the hand and upper extremity physical examination as they pertain to identifying vascular pathology, as well as current state of the art diagnostic modalities. Finally, we discuss some of the more common conditions that affect the hand and upper extremity leading to upper extremity ischemia. The reader should come away with a clear understanding of hand and upper extremity vascular anatomy, how to perform a focused physical examination to identify relevant pathology, and which diagnostic modalities will be most appropriate to make a diagnosis. This review contains 9 figures and 52 references. Key words: Allen test, aneurysm, arteriography, botulinum toxin, Buerger disease, CT angiography, hypothenar hammer syndrome, ischemia, magnetic resonance angiography, Raynaud phenomenon, sympathectomy vascular anatomy, vascular pathology