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Cold Hand Clinic: Treatment

University of Chicago hand surgeons offer distinct clinical expertise and a comprehensive range of diagnostic and treatment services for cold hands syndrome, including surgical and non-surgical techniques. In the Cold Hand Clinic, we combine traditional and innovative approaches to determine the most effective therapeutic strategy for each individual.

Behavioral Counseling
Botox Injections
Surgical Treatment
Hand Therapy and Rehabilitation

Behavioral Counseling

In the Cold Hand Clinic, we will help you identify behaviors that may be helpful or harmful to blood flow in your the hands. Our doctors educate patients on a range of behavioral topics, including:

  • Proper hand hygiene (e.g., correct moisturizing options, appropriate skin care)
  • Wearing warm and protective hand wear (e.g., guidance in glove type choices and usage)
  • Healthy temperature regulation
  • Biofeedback
  • Smoking cessation

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In many cases, our doctors may prescribe medicines that reduce the risk of developing blocked or constricted blood vessels, and improve blood flow through the hands and fingers.

Effective medications include:

  • Calcium channel blockers: oral and topical medications used to relax the muscles that place pressure on blood vessels
  • Antidepressants: used with calcium channel blockers to regulate pressure in the blood vessels and help maintain a proper amount of blood flow throughout the entire hand
  • Anticoagulants (blood thinners): oral medications used to reduce the risk of blood clotting and other blockages of blood flow through upper limb vessels

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Botox Injections

Most commonly recognized as a cosmetic procedure, botulinum toxin type A (Botox or BTX -A) injections are now used as a highly effective treatment for cold hands syndrome. In a simple outpatient procedure, Botox is injected into the hand to relax muscles surrounding constricted blood vessels. Botox paralyzes and relaxes the muscles, allowing blood vessels to dilate and increase in diameter. As the vessels dilate, more blood can flow through to supply the rest of the hand and the fingertips. This procedure may provide relief of cold hand symptoms in certain individuals for up to three months.

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Surgical Treatment

Digital sympathectomy Digital sympathectomy

Surgery is often the best treatment option for complex cold hand diseases. Our highly skilled hand surgeons perform a range of advanced techniques with expert precision.

Surgical treatment options include:

  • Sympathectomy: a microsurgical technique used to separate the nerves and vessels in the forearm, palm (palmar sympathectomy) or fingers (digital sympathectomy). When nerves are separated, the vessels become larger, allowing increased blood flow through the hands and fingertips.
Fingertip ulcer before and after periarterial sympathectomy
  • Aneurysm repair: repair of an aneurysm by inserting a stent to strengthen a weak blood vessel, or aneurysm removal followed by replacement with a graft of healthy vascular tissue
  • Thrombectomy: blood clot removal using microsurgery techniques
  • Vascular bypass: a procedure that redirects blood flow around an obstructed segment of the blood vessel

Soft Tissue Reconstruction

If a patient experiences severe loss of blood flow, dead tissue (i.e., gangrene, necrosis) may form in their hands and/or fingers. In these highly complex cases, our hand surgeons may perform one of two advanced treatment techniques:

  • Acellular dermal matrix: an innovative technique, using artificial tissue or tissue from a human or animal donor, to stimulate the growth of healthy tissue
  • Vascularized free tissue transfer (free flap transfer): a technique using skin grafts (healthy tissue that has been removed from the abdomen or elsewhere in the patient's body) to repair and replace severely damaged tissue

Both methods are highly effective surgical therapies for hands impaired by vascular disease. However, acellular dermal matrix is a leading-edge technique with a lower risk of complication, because it does not require the removal of tissue from elsewhere in the patient's body.

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Hand Therapy and Rehabilitation

Hand therapy is often necessary in the treatment of circulatory disorders and peripheral nerve injuries, and also in post-surgical rehabilitation care. In these cases, our physician team works closely with skilled hand therapists to provide the most effective care. With training and expertise in occupational therapy, our hand therapy team specializes in assessment, injury prevention, and rehabilitation.

We offer a range of hand therapy services, including:

  • Pain management
  • Swelling control (edema management)
  • Advanced and complex wound care (including hydrotherapy, provided in partnership with the physical therapy team)
  • Scar tissue mobilization/management, including scar massage and other techniques, to increase range of motion (ROM) by decreasing adhesion formation (tightness) after surgical procedures
  • Digital amputation care
  • Desensitization
  • Exercises to strengthen weakened hands
  • Splinting
  • Activity modification counseling

All patients undergo a thorough activities of daily life (ADL) assessment in their hand therapy work-up. The ADL assessment is an evaluation of a person's ability to perform daily tasks with their hands, such as bathing, dressing, eating, and other activities. Based on ADL assessment outcomes, the physician and the hand therapist work closely to coordinate an individualized treatment and therapy plan tailored to the specific needs and medical history of each patient. ADL assessments also help hand therapists educate patients, by identifying and providing specific behavioral and safety recommendations for hand health and functionality.

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More Information

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