Noninvasive evaluation of the upper extremity

B. T. Baxter, D. Blackburn, K. Payne, W. H. Pearce, J. S.T. Yao

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Vascular problems of the arm and hand can be assessed by a number of noninvasive modalities that are chosen on the basis of the history and physical examination. For suspected upper-extremity ischemia, we begin with SLPs and velocity-waveform analysis. The former test will define the extent and approximate location of the disease process, and subjective assessment of the waveform will further determine the degree and location of occlusive disease. When digital ischemia is suspected, the Doppler examination combined with intermittent compression of the radial and ulnar arteries is valuable for defining the variable arterial anatomy of the hand and the patency of the common and proper digital arteries. The extent of distal ischemia can be assessed by digital pressures. Duplex scanning has been found to be of value in determining the source of upper-extremity microemboli, in imaging suspected aneurysmal changes, and for evaluating arteriovenous fistulae and bypass grafts. Cold testing is used to confirm the diagnosis of Raynaud's disease after excluding proximal occlusive disease. When symptoms suggest intermittent arterial obstruction, arterial compression at the thoracic outlet is assessed by monitoring the arterial waveform during a series of maneuvers that change the anatomy of the outlet. Although a combination of IPG and venous Doppler examination acurately identifies venous occlusion, we routinely use duplex scanning in this setting. In addition to providing both anatomic and hemodynamic information about the subclavian vein, the jugular vein and the junction of the innominate vein can also be studied. Because of its ability to image in a coronal plane, MRI scanning is another noninvasive study that we have found useful for evaluation of venous anatomy and patency of the subclavian, jugular, and innominate veins. Venous thrombosis, often the first manifestation of subclavian vein compression at the thoracic inlet, is best evaluated using duplex scanning.

Original languageEnglish (US)
Pages (from-to)87-97
Number of pages11
JournalSurgical Clinics of North America
Volume70
Issue number1
DOIs
StatePublished - Jan 1 1990

Fingerprint

Subclavian Vein
Upper Extremity
Brachiocephalic Veins
Anatomy
Ischemia
Jugular Veins
Thorax
Hand
Ulnar Artery
Raynaud Disease
Radial Artery
Process Assessment (Health Care)
Arteriovenous Fistula
Venous Thrombosis
Physical Examination
Blood Vessels
Arm
Arteries
Hemodynamics
History

ASJC Scopus subject areas

  • Surgery

Cite this

Noninvasive evaluation of the upper extremity. / Baxter, B. T.; Blackburn, D.; Payne, K.; Pearce, W. H.; Yao, J. S.T.

In: Surgical Clinics of North America, Vol. 70, No. 1, 01.01.1990, p. 87-97.

Research output: Contribution to journalArticle

Baxter, B. T. ; Blackburn, D. ; Payne, K. ; Pearce, W. H. ; Yao, J. S.T. / Noninvasive evaluation of the upper extremity. In: Surgical Clinics of North America. 1990 ; Vol. 70, No. 1. pp. 87-97.
@article{36d302a7a69d4050a9f160f2227cfa6f,
title = "Noninvasive evaluation of the upper extremity",
abstract = "Vascular problems of the arm and hand can be assessed by a number of noninvasive modalities that are chosen on the basis of the history and physical examination. For suspected upper-extremity ischemia, we begin with SLPs and velocity-waveform analysis. The former test will define the extent and approximate location of the disease process, and subjective assessment of the waveform will further determine the degree and location of occlusive disease. When digital ischemia is suspected, the Doppler examination combined with intermittent compression of the radial and ulnar arteries is valuable for defining the variable arterial anatomy of the hand and the patency of the common and proper digital arteries. The extent of distal ischemia can be assessed by digital pressures. Duplex scanning has been found to be of value in determining the source of upper-extremity microemboli, in imaging suspected aneurysmal changes, and for evaluating arteriovenous fistulae and bypass grafts. Cold testing is used to confirm the diagnosis of Raynaud's disease after excluding proximal occlusive disease. When symptoms suggest intermittent arterial obstruction, arterial compression at the thoracic outlet is assessed by monitoring the arterial waveform during a series of maneuvers that change the anatomy of the outlet. Although a combination of IPG and venous Doppler examination acurately identifies venous occlusion, we routinely use duplex scanning in this setting. In addition to providing both anatomic and hemodynamic information about the subclavian vein, the jugular vein and the junction of the innominate vein can also be studied. Because of its ability to image in a coronal plane, MRI scanning is another noninvasive study that we have found useful for evaluation of venous anatomy and patency of the subclavian, jugular, and innominate veins. Venous thrombosis, often the first manifestation of subclavian vein compression at the thoracic inlet, is best evaluated using duplex scanning.",
author = "Baxter, {B. T.} and D. Blackburn and K. Payne and Pearce, {W. H.} and Yao, {J. S.T.}",
year = "1990",
month = "1",
day = "1",
doi = "10.1016/S0039-6109(16)45035-8",
language = "English (US)",
volume = "70",
pages = "87--97",
journal = "Surgical Clinics of North America",
issn = "0039-6109",
publisher = "W.B. Saunders Ltd",
number = "1",

}

TY - JOUR

T1 - Noninvasive evaluation of the upper extremity

AU - Baxter, B. T.

AU - Blackburn, D.

AU - Payne, K.

AU - Pearce, W. H.

AU - Yao, J. S.T.

PY - 1990/1/1

Y1 - 1990/1/1

N2 - Vascular problems of the arm and hand can be assessed by a number of noninvasive modalities that are chosen on the basis of the history and physical examination. For suspected upper-extremity ischemia, we begin with SLPs and velocity-waveform analysis. The former test will define the extent and approximate location of the disease process, and subjective assessment of the waveform will further determine the degree and location of occlusive disease. When digital ischemia is suspected, the Doppler examination combined with intermittent compression of the radial and ulnar arteries is valuable for defining the variable arterial anatomy of the hand and the patency of the common and proper digital arteries. The extent of distal ischemia can be assessed by digital pressures. Duplex scanning has been found to be of value in determining the source of upper-extremity microemboli, in imaging suspected aneurysmal changes, and for evaluating arteriovenous fistulae and bypass grafts. Cold testing is used to confirm the diagnosis of Raynaud's disease after excluding proximal occlusive disease. When symptoms suggest intermittent arterial obstruction, arterial compression at the thoracic outlet is assessed by monitoring the arterial waveform during a series of maneuvers that change the anatomy of the outlet. Although a combination of IPG and venous Doppler examination acurately identifies venous occlusion, we routinely use duplex scanning in this setting. In addition to providing both anatomic and hemodynamic information about the subclavian vein, the jugular vein and the junction of the innominate vein can also be studied. Because of its ability to image in a coronal plane, MRI scanning is another noninvasive study that we have found useful for evaluation of venous anatomy and patency of the subclavian, jugular, and innominate veins. Venous thrombosis, often the first manifestation of subclavian vein compression at the thoracic inlet, is best evaluated using duplex scanning.

AB - Vascular problems of the arm and hand can be assessed by a number of noninvasive modalities that are chosen on the basis of the history and physical examination. For suspected upper-extremity ischemia, we begin with SLPs and velocity-waveform analysis. The former test will define the extent and approximate location of the disease process, and subjective assessment of the waveform will further determine the degree and location of occlusive disease. When digital ischemia is suspected, the Doppler examination combined with intermittent compression of the radial and ulnar arteries is valuable for defining the variable arterial anatomy of the hand and the patency of the common and proper digital arteries. The extent of distal ischemia can be assessed by digital pressures. Duplex scanning has been found to be of value in determining the source of upper-extremity microemboli, in imaging suspected aneurysmal changes, and for evaluating arteriovenous fistulae and bypass grafts. Cold testing is used to confirm the diagnosis of Raynaud's disease after excluding proximal occlusive disease. When symptoms suggest intermittent arterial obstruction, arterial compression at the thoracic outlet is assessed by monitoring the arterial waveform during a series of maneuvers that change the anatomy of the outlet. Although a combination of IPG and venous Doppler examination acurately identifies venous occlusion, we routinely use duplex scanning in this setting. In addition to providing both anatomic and hemodynamic information about the subclavian vein, the jugular vein and the junction of the innominate vein can also be studied. Because of its ability to image in a coronal plane, MRI scanning is another noninvasive study that we have found useful for evaluation of venous anatomy and patency of the subclavian, jugular, and innominate veins. Venous thrombosis, often the first manifestation of subclavian vein compression at the thoracic inlet, is best evaluated using duplex scanning.

UR - http://www.scopus.com/inward/record.url?scp=0025240368&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0025240368&partnerID=8YFLogxK

U2 - 10.1016/S0039-6109(16)45035-8

DO - 10.1016/S0039-6109(16)45035-8

M3 - Article

C2 - 2406976

AN - SCOPUS:0025240368

VL - 70

SP - 87

EP - 97

JO - Surgical Clinics of North America

JF - Surgical Clinics of North America

SN - 0039-6109

IS - 1

ER -