Cold Hand Clinic: Frequently Asked Questions

How can I tell if my hands are abnormally cold?

If your hands are abnormally cold, you may notice one or more of the following signs:

  • Your hands are cold even in mild temperatures, when others around you do not have cold hands.
  • You feel pain in your fingers in cold temperatures.
  • You need to wear gloves when handling frozen foods in the grocery store.
  • Your hands change color (e.g., red, white and/or blue).
  • Minor wounds on your fingertips do not heal easily.

In any of these cases, the most important step you can take toward better hand health is to be examined by a hand specialist.

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What causes cold hands syndrome?

There are two major vascular disease processes that cause cold hands syndrome: vasoconstriction and vaso-occlusion.

Vasoconstriction, which means narrowing in one or more blood vessels of the hand or wrist, is essentially part of a normal regulation process. When you're cold, your body temporarily applies more muscle pressure to major arteries, sending more blood and warmth to critical organs (such as your heart, lungs, and brain), and less blood to your extremities (hands and feet). Vasoconstriction becomes a problem when it's abnormally strong or prolonged.

Vaso-occlusion refers to a blockage of one or more blood vessel(s) in the hand or wrist.

To understand how vasoconstriction and vaso-occlusion cause cold hands, think of a garden hose watering a lawn. The hose is like your blood vessels; the water is like your blood; and the lawn is like your hand. If you step on the hose, you decrease or block the flow of the water to the lawn. As you take your foot off the hose, more water flows to the lawn. If someone always has a foot on your garden hose, the decreased flow of water will cause your lawn to eventually wither, changing in color from green to brown. The same thing can happen with your hands; with insufficient blood flow and warmth, they become cold, changing in color from pink to white to blue.

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How are Raynaud's and other diseases associated with cold hands syndrome?

There are several conditions that can cause cold hands syndrome, including autoimmune, connective tissue and vascular diseases. Characterized by decreased blood flow to the extremities, Raynaud's is one of the most common examples. In this disease process, exposure to cold (or stress) can trigger spasms in the blood vessels of the hand. There are actually two vascular disease processes categorized as Raynaud's: Raynaud's disease (primary) and Raynaud's phenomenon (secondary).

When the effects of Raynaud's (decreased blood flow and vascular spasms in the hands) occur without any additional disease that may be causing them, the condition is Raynaud's disease -- also called primary Raynaud's. In women, Raynaud's disease often develops in the teenage years or early in adulthood. Primary Raynaud's is thought to be at least partially hereditary, although specific genes have yet to be identified.

When there is a concurrent autoimmune, connective tissue or vascular disease involved, the condition is Raynaud's phenomenon -- also called secondary Raynaud's. Diseases associated with Raynaud's phenomenon include:

  • Systemic lupus erythematosus
  • Scleroderma
  • Systemic sclerosis
  • Rheumatoid arthritis
  • CREST syndrome
  • Sjögren's syndrome
  • Buerger's disease (thromboangitis obliterans)
  • Obstructive arterial disease

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How does cold hands syndrome cause tissue damage?

When blood flow to the hands is restricted, oxygen content in the fingers becomes depleted and the hands turn blue, a process called cyanosis.

As the fingers become warm again, the increased blood flow turns the hands red -- which is often a painful process. Once the fingers return to normal skin color, the patient may notice swelling and tingling in the hand.

If the process becomes worse, the repeated and increasingly prolonged depletion of blood flow to the fingers can cause ulcers on the skin and dead (necrotic) tissue.

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How does the body normally keep hands warm?

To understand what causes cold hands, you must first understand how the body normally keeps hands warm. Our bodies keep our hands warm primarily by regulating blood flow from the heart, down the arm and all the way to the fingertips. Blood that flows into our hands usually travels through two arteries: the radial artery and the ulnar artery. These arteries course through the forearm into the hand on either side of the wrist. When looking at your palm, the radial artery is on the thumb side; the ulnar artery is on the small finger side. Both arteries join together in the palm and send off branches to each finger. More blood to the hands means pink, warmer hands. Less blood flow means colder -- sometimes painful -- hands.

The amount of blood that flows through arteries and veins is centrally controlled by how much, how fast and how well the heart pumps. However, the heart does not control the amount of blood that flows to each region of the body; a layer of muscles (musculature) that surround arteries throughout the body controls that process. When the muscles contract, the blood vessel lumen (the cross-section of the blood vessel) becomes smaller and narrower. As the blood vessels narrow, less blood flows downstream to specific regions of the body -- a process called vasoconstriction.

A person's autonomic nervous system controls the contraction or relaxation of the muscles surrounding the arteries. In the hands or feet of Raynaud's patients, there is an abnormal, excessive amount of arterial musculature, which decreases blood flow. Many of the innovative treatments administered at the University of Chicago medical center focus on re-establishing a more balanced or relaxed condition for this musculature.

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Conditions

  • Carpal tunnel syndrome
  • Circulatory disorders
  • Cold hands syndrome
  • Hypothenar hammer syndrome
  • Ischemia
  • Lupus (systemic lupus erythematosus)
  • Occlusive disorders
  • Raynaud's disease
  • Raynaud's phenomenon/syndrome
  • Rheumatoid arthritis (RA)
  • Scleroderma
  • Thrombosis
  • Vasospastic disorders