Drs Sonia Arunabh and K. Rauhilla's case of a 62-year-old woman with Raynaud's
phenomenon (CONSULTANT, September 15, 2001, page 1526) offers one of
the finest photographs of this condition that I have seen (Figure). The patient had
hypertension and diabetes mellitus, and she had been a heavy smoker for many
years. Rheumatologic and endocrine workups were negative. Primary Raynaud's
phenomenon was diagnosed, and a calcium channel blocker was prescribed, which
ameliorated the patient's symptoms.
In their case report, however, the authors did not discuss what appears to be
marked thenar atrophy or the patient's extremely tight rings. The transverse markings
on the volar aspect of the wrist are also of interest—or perhaps they are only
Median nerve compression and carpal tunnel syndrome may be the cause of
her muscle wasting. Were an electromyelogram and a nerve conduction study done?
Also, what were the results of her most recent thyroid evaluation? Hypothyroidism
can 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
You are certainly an astute
clinician! Results of the
patient's thyroid function
tests were normal, and she
has been advised about
the rings before. We had postponed
doing an electromyelogram and
nerve conduction study while treating
the Raynaud's phenomenon. However,
since this case study appeared,
nerve conduction studies have been
performed. These did not reveal
carpal tunnel syndrome; nonetheless,
the patient feels better using
splints on her hands.
— Sonia Arunabh, MD
New Hyde Park, NY