2. Traumatic vasospastic disease. Persons who are exposed to repetitive trauma to the digits are at increased risk for the development of RP. It has been postulated that chronic stimulation of the pacinian corpuscles in the hands may result in digital artery vasospasm through a reflex that involves the sympathetic system. It most commonly occurs in workers who use vibratory tools such as pneumatic hammers and chain saws. The term vibration-induced white finger is used for this condition. Typists and pianists may also be affected. Interestingly, frostbite predisposes to the development of RP in the body parts involved.
3. Occlusive arterial disease. Atherosclerosis and thromboangiitis obliterans (Buerger's disease) may result in RP in the distribution of the narrowed blood vessels. Thrombotic or embolic occlusions of digital or larger proximal arteries are also in the working differential diagnosis.
4. Nerve compression. RP can result from a thoracic outlet syndrome. Compression (e.g., by a cervical rib or a pectoralis minor tendon) of brachial plexus sympathetic fibers and the subclavian artery have been implicated. RP may also be seen in patients with the carpal tunnel syndrome.
5. Drugs and chemicals. Ergot alkaloids have a direct vasoconstrictive action on blood vessels. Methysergide may cause intimal fibrosis. Exposure to vinyl chloride and bleomycin can cause a scleroderma-like illness with RP. Beta blockers, sympathomimetics, cocaine, cyclosporine, interferon-alfa, vinblastine, and cisplatin have been all implicated in the development of RP.
6. Hematologic abnormalities. RP has been reported in cryoglobulinemia, cold agglutinin disease, polycythemia, and macroglobulinemia. Blood hyperviscosity is the presumed underlying mechanism.
7. Other disorders associated with RP include malignancy, and hypothyroidism.
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