Vascular Disorders of the Upper Extremity
Hand and Finger Procedures & Conditions | Dr. William Van Wyk, DFW Hand Surgeon
Vascular Disorders of the Upper Extremity
Hand and Finger Procedures & Conditions | Dr. William Van Wyk, DFW Hand Surgeon
Vascular Disorders
Vascular disorders of the upper extremity are uncommon, but ones that may have lasting implications.
Anatomy
Arteries bring oxygenated blood from the heart to the fingertips and veins return the used blood back to the heart and lungs.
Click image to enlarge
Photo Credit: American Society for Surgery to the Hand
At the level of the wrist 2 major arteries bring blood into the hand: the radial and ulnar arteries (Fig. 1). Variations in the anatomy are common, though, which may affect the way blood flow ultimately reaches each finger.
Symptoms of vascular insufficiency include:
- pain
- color changes in the fingertips
- ulcers which do not heal
- cold intolerance
- numbness or tingling of the fingertips
- local areas of swelling around the vessels
Click image to enlarge
Photo Credit: American Society for Surgery to the Hand
Examination:
- presence and quality of the pulses at the armpit, elbow, wrist and finger levels
- Edema (swelling)
- vein distension
- discoloration
- fingertips ulceration, gangrene
- masses location, color, size, duration, character
- temperature
Diagnostic Tests
A variety of tests may be used to evaluate vascular disorders, such as:
Click image to enlarge
Photo Credit: American Society for Surgery to the Hand
- Doppler or ultrasound examination of the blood flow in the arteries and veins (Fig. 2)
- Segmental arterial pressure and pulse volume recordings, which assess the quality of blood
flow in the vessels using small blood pressure cuffs and ultrasound transducers placed on
the fingers and arm. - Magnetic resonance angiography. A MRI of the affected area is performed with special
attention dedicated to the vessels (MRI/MRA) (Fig. 3).
Click image to enlarge
Photo Credit: American Society for Surgery to the Hand
- Cold stress test used to assess the severity and reversibility of vessel spasm. The
temperature and blood pressure in the finger(s) are recorded before and after the hand is
immersed in cold water. - Arteriography. Contrast is injected into the vessel and X-rays taken of the hand and arm. This
is the most invasive test but also depicts the most detail of the vessels.
Common Conditions causing vascular problems:
Trauma Penetrating trauma such as a knife wound may damage the blood vessel. Occasionally, a seemingly innocuous cut appropriately located will cause major damage,
or sometimes a blunt injury can bruise the vessels enough to cause a clot and stop the blood from flowing to the fingertips, which turn white, cold, and painful. Immediate reconstruction is usually necessary if blood flow has stopped. Other injuries may not be as severe, since there may be a variety of different arteries that can continue to provide blood flow to the area.
Aneurysms: An aneurysm is a localized weakness of the vessel wall that results in an isolated expansion of the vessel, like a balloon popping up (Fig. 4). Usually these present as a soft painless mass over the vessel. The vessel may become blocked through the formation of a blood clot or may even shower small clots to the fingertips. Aneurysms of the wrist may cause cold intolerance, pain or numbness as they enlarge, and can occasionally cause gangrene of the fingertips.
Vascular malformations: When an abnormal connection exists between the veins and arteries, excess blood is shunted through these small vessels, which may become large and produce symptoms. When a significant volume of blood is re-directed through these small connecting vessels, patients can experience pain, sweating in the area, heaviness, increased temperature and hair growth, and spontaneous bleeding. When small, treatment may be as simple as a compression glove. However, when large and destructive, treatment might require surgical excision.
Raynaud’s Phenomenon/Disease: This describes a condition in which the arteries in the fingers go into spasm, depriving the finger of blood flow. The fingers typically change color, going from white to blue, then red as the spasm resolves and blood flow returns. It often occurs when the hand is exposed to cold or tobacco. Treatment entails cessation of smoking, avoiding cold weather, use of protective garments (e.g. mittens, gloves), and occasionally medicines that can help dilate the vessels and improve blood flow to the fingertips. When unresponsive to these measures or a non-healing ulcer is present, surgery to separate the nerves from around the vessels may be considered, to relieve the effect of the sympathetic nerves that contributes to spasm of the arteries
My wife and I’ve been patients . . . for close to three decades.
Yelp Review, Chuck E., Fort Worth, April 1, 2024
My wife and I’ve been patients of Dr. Van Wyk for close to three decades. As many of the reviews note, it all starts with the staff, and they are wonderful. What I love is the playful banter between the staff and Dr. Van Wyk. There is truly a lot of “love” in his office between doc and the staff. They all adore the doc and doc adores the staff. He kids around with them telling them it’ll be hard for them to keep up with him. I don’t know his exact age, but I believe he’s been a surgeon for over five decades. There is no better hand doctor around. He’s never in a hurry during our appointments and is always upbeat.
Board Certified Orthopedic Surgeon Specializing in Hand & Upper Extremity Surgery in Fort Worth Since 1977
Dr. Van Wyk is a hand and upper extremity specialist actively practicing in Fort Worth since 1977. Dr. Van Wyk is board-certified in orthopedic surgery and has practiced in that specialty. He passed the added qualification in hand surgery exam and has limited his practice to 100% hand and upper extremity surgery.
In Dr. Van Wyk’s practice, upper extremity surgery refers to the elbow, forearm, wrist and hand. As a hand specialist, he sees approximately 300 hand patient visits per month and performs on average 90-100 surgical procedures per month. Dr.Van Wyk is a member of the American Society for Surgery the Hand, American Academy of Orthopedic Surgery, the American Board of Orthopedic Surgery, Fort Worth-Dallas Hand Association, the American Medical Association, and the Tarrant County Medical Association.
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