Basic Facts

The medical term for upper extremity disease is peripheral arterial disease, or PAD. Arteries carry blood away from the heart to the head, torso, arms, and legs.

Upper extremity disease, also called arm artery disease, can prevent blood from reaching parts of the shoulders, arms or hands.

Common first symptoms of upper extremity disease include arm weakness during exercise, pain in the fingers, or hypersensitivity to cold. As the disease progresses, painful ulcers may develop on the fingers.

In upper extremity disease, an artery between the chest and the hand becomes partially or completely blocked. Upper extremtiy disease can be acute, meaning that it comes on quickly. However, it is usually chronic, meaning it progresses slowly over a long period of time. One early symptom is pain when moving the arms. As the disease progresses, pain can occur in the arms at rest. In advanced stages, the disease may cause skin ulcers and cell death from lack of oxygen and nutrients.

One of the main causes of upper extremity disease is atherosclerosis, or hardening of the arteries.

WHAT ARE THE SYMPTOMS?

In most people, there are no symptoms until a blockage in the artery or vein prevents more than half of the blood from passing through. Symptoms include:

• Pain;
• Blisters and ulcers (sores);
• Gangrene (tissue death);
• Weak or absent pulse;
• Muscle atrophy (wasting);
• Cool skin temperature;
• Bluish, slow-growing nails;
• Hair loss in the arm;
• Swelling;
• A nerve condition called ischemic neuritis; and
• Bruits (abnormal sounds of blood flow that are detected by stethoscope).

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CAUSES AND RISK FACTORS

A primary cause of upper extremity disease is atherosclerosis, or hardening of the arteries.

Several other conditions can cause upper extremity disease. They include:

• Vasculitis;
• Buerger's disease, also known as thromboangiitis obliterans;
• Takayasu's disease, an autoimmune disease;
• Raynaud's phenomenon;
• Thromboembolism; and
• Subclavian steal syndrome.

Upper extremity disease primarily affects cigarette smokers and people older than 60. Other risk factors include:

• Advanced age;
• Male gender;
• Diabetes mellitus;
• High cholesterol; and
• High blood pressure.

DIAGNOSIS

To diagnose upper extremity disease, a physician will ask questions about a patient's history and perform a physical examination, which may include feeling for a pulse in the extremities and listening to the arteries with a stethoscope. The physician may also order imaging tests, such as:

• Doppler flow velocity waveform analysis;
• Duplex ultrasound;
• Segmental blood pressure;
• Magnetic resonance angiography (MRA); and
• Angiogram.

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TREATMENT APPROACH

Treatments for upper extremity disease depend on the cause, location, and severity of the problem, and may include medications such as:

• Platelet inhibitors;
• Thrombolytic drugs; or
• Vascular endothelial growth factor

If a patient has an underlying condition, such as diabetes, treating that condition may improve symptoms of upper extremity disease.

LIFESTYLE

Patients should address risk factors for the causes of the disease by making the following lifestyle changes:

• Quitting smoking;
• Eating a healthy diet; and
• Exercising.

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