A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure, pulse, body weight, height; further:
- Inspection (viewing) of skin [due tosymptoms of fingers/toes (tricolor phenomenon):
- Paleness (white).
- Acrocyanosis (blue)
- Skin redness (red)]
- Inspection (viewing) of skin [due tosymptoms of fingers/toes (tricolor phenomenon):
- Studies of blood flow to the hands, especially by the following clinical tests:
- Fist-closing test (patient raises arms and closes and opens fist 60 times within two minutes; in normal cases, that is, with good blood flow, the skin of the hand remains rosy; in peripheral arterial disease (PAVD), pale spots appear on the palm and the inside of the fingers) or
- Allen test can test the palmar arcus (radial and ulnar arteries) for circulatory disorders;
- Circulatory disturbance of an artery: both arteries are squeezed, blood in the hand is pumped peripherally out of the hand by opening and closing the hand several times, and then the occlusion of the artery to be tested is released. Normal finding: the hand fills with blood again within a few seconds. Pathological (pathological) finding: No filling within a few seconds (→ circulatory disturbances in the tested artery).
- Unilateral blood supply of the palmar arch: here, the impression of a feeding artery and the observation of the blood supply to the hand. Normal finding: no whitening of the hand Pathological finding: whitening of the skin (→ insufficient blood supply through the non-compressed artery; cause, for example, the absence of anastomoses of both supply areas or circulatory disorders).
- Cold provocation test (after a cold water bath (12 °C, 5 minutes), infrared thermography is used to measure the fingertip temperature during the following 25 minutes. The rewarming course of the fingers allows to determine whether a possible circulatory disorder (vasospastic attack) is present); if the test is positive, a primary Raynaud’s syndrome is very probable
- Health check
Square brackets [ ] indicate possible pathological (pathological) physical findings.
