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History and examination

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Raynaud's phenomenon is diagnosed clinically and requires that a number of points be covered during the history and examination:

In the history:

  • classical triphasic changes in the colour of the extremities, inquire about
  • the frequency and pattern of colour changes and at which stage(s) they experience
    • not all of the three phases are needed to make a diagnosis
    • an attack may last for minutes to hours.
  • which digits are affected
  • associated features such as pain and changes in sensation
    • patients may complain of tightness in the first two stages and burning pain in the reperfusion stage.
  • what triggers an attack e.g. - drug exposure (beta-blockers, oral contraceptives), use of vibrating machinery, work in cold environment (fishing industry)
  • what relieves it
  • a systemic inquiry to identify secondary causes
  • any evidence of a rash, photosensitivity, migraines, joint pains, ulcers, dysphagia, and xerostomia.
  • drug treatment history (such as beta­blockers)
  • occupational history (such as use of a vibratory tool)
  • family history (to check for genetic components to both primary Raynaud phenomenon and systemic sclerosis) (1,2)

On examination:

Focus of examination may vary according to the clues from the history

  • hands
  • look for colour changes, nail bed changes, and skin integrity.
  • sclerodactyly, flexion deformities, tendon friction rubs and calcinosis are present in systemic sclerosis
  • digital ulceration if present indicate secondary cause
  • feel for limb pulses
  • move all joints and assess for pain and contracture
  • face
  • malar rash, non-scarring alopecia, and oral ulcers suggesting systemic lupus erythematous,
  • tightening of the skin seen in systemic sclerosis
  • dry skin, telangiectasia, and the salt and pepper appearance of hyperpigmentation and hypopigmentation, which are indicative of systemic sclerosis.
  • livedo reticularis, suggesting systemic lupus erythematous or antiphospholipid syndrome
  • measure blood pressure in both arms: possible obstructive vascular lesion in the subclavian or axillary arteries
  • note that a unilateral Raynaud's phenomenon affects a single limb when there is local pathology e.g. Raynaud's phenomenon in only a single foot may be secondary to a popliteal aneurysm (1,2)


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