Upper-Extremity Arterial Occlusive Disease Clinical Presentation

Updated: Sep 20, 2022
  • Author: Mark K Eskandari, MD; Chief Editor: Vincent Lopez Rowe, MD  more...
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The patient’s history may include the following:

  • Arm fatigue upon exercise (ie, subclavian artery occlusion)
  • Vertebrobasilar insufficiency (ie, subclavian steal)
  • Rest pain that involves hand and digits
  • Digital gangrene
  • Raynaud syndrome (eg, color changes—white, blue, red or white, red, blue)
  • Smoking history
  • Occupational and recreational history (eg, baseball pitcher, tennis player, handballer, or carpenter)
  • Drug ergots (peripheral vasoconstrictors used in the treatment of shock [eg, dopamine and adrenaline])

Physical Examination

The results of physical examination may include the following:

  • Fever (if an associated vasculitis is present)
  • Unequal arm pressures (difference >20 mm Hg)
  • Supraclavicular or infraclavicular bruit
  • Adson maneuver (loss of radial pulse upon abduction and external rotation of the upper extremity)
  • Supraclavicular pulsatile mass (associated with a subclavian aneurysm or cervical rib)
  • Palpation of pulses (axillary, brachial, radial, or ulnar)
  • Digital gangrene
  • Color and capillary refill of the digits
  • A positive Allen test result

An abnormal Allen test result demonstrates an incomplete palmar arch. In this test, the ulnar and radial arteries are occluded with the fist clenched. The hand is then opened, releasing one of the arterial occlusions (radial or ulnar); prompt capillary refill should result. The same maneuver should then be performed with the release of the other artery. If the palmar arch is not intact, the release of the affected artery produces a sluggish capillary refill.

Alternatively, a Doppler stethoscope is used to map these collateral flow patterns in the hand by manually occluding, one at a time, the radial and ulnar arteries.