Scenario: A 56-year-old female presents with bilateral hand and finger pain with a diagnosis of Raynaud syndrome. She states that her hands and fingers are always cold. She especially has difficulty in the supermarket when reaching for frozen foods. She notices her fingers go blue and then white. She states the pain occurs when they start to warm up. She carries gloves with her even during the summer months.

Loss of pulp of the pad of the digit with pitting scars and ulcerations from chronic, severe Raynaud phenomenon. (From Goldsmith LA, Katz SI, Gilchrest BA, et al. Fitzpatrick’s Dermatology in General Medicine. 8th ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

Question: What would be an ideal alternative intervention to teach the patient to assist with limiting her attacks and the severity of their symptoms during daily errands, such as to the grocery store?

Potential answers:

1. Lifestyle changes to limit effects of the syndrome
2. Therapeutic exercise to limit symptoms during attacks
3. Biofeedback interventions to encourage vasodilation
4. All of the above.

Answer with rationale:  All of the above.

Lifestyle changes such as diet and exercise alterations can make a difference in number and intensity of symptoms and attacks. A specific example would be limiting daily alcohol, nicotine, and caffeine intake. These have all been shown to increase severity and number of attacks in a portion of the population who have Raynaud syndrome.

Therapeutic exercises including windmills, wrist circles, and finger stretches can all assist during episodes of Raynaud’s Syndrome to decrease symptoms. These exercises can help to limit mobility deficits caused during and after attacks by keeping blood flow moving more normally. A regular exercise routine can also help by improving general circulation throughout the body.

Biofeedback interventions encouraging vasodilation can also help during attacks. Biofeedback training teaches patients to control circulation within affected areas through a specific set of behaviors. This training is initially completed with sensors that show the patient how well the behaviors are working to increase circulation and temperature within the area. The patients then have this at their disposal for future attacks.

For more information see Chapter 16 Raynaud Syndrome in the Color Atlas of Physical Therapy