A 45-Year-Old Woman Presenting With Painful Fingers

A 45-year-old woman with hypothyroidism presents to your office complaining of painful fingers. When exposed to cold temperatures, the fingers on her right hand become markedly cold, pale, stiff, and achy. Upon questioning, she denies involvement of her thumbs, fingers on her left hand, or toes, and the skin changes do not extend beyond the digits. She has noticed these symptoms for the past two years, but they have increased in severity this winter, as she has been forced to spend more time shoveling snow. Her symptoms resolve with warming, and she has been wearing gloves, even while indoors, to help prevent attacks. There is no skin breakdown or discoloration that persists after warming. She denies any tobacco or illicit drug use or family members with similar symptoms.

On exam, there is pallor of the third, fourth, and fifth digits of the right hand (Figure 1), and these digits are cold to touch with sluggish capillary refill. The digits of the left hand are unaffected. After she wraps her hands in a warm blanket for several minutes, the digits return to normal. Nailfolds are smooth and uniformly pink. The skin is intact without sclerodactyly. Radial and ulnar arterial pulses are 2+ bilaterally.

Figure 1

Figure 1

Given the description and physical exam, which of the following describes the most likely diagnosis?

Show Answer