Incidence of thoracic outlet syndrome on the epidemiology and clinical presentation of apparently primary Raynaud's phenomenon. A prospective study in 570 patients.

In the absence of established criteria enabling a Raynaud's phenomenon to be related to a thoracic outlet syndrome, the authors attempted to assess whether the presence of objective clinical features of thoracic outlet might modify the epidemiology or the clinical presentation of Raynaud's phenomenon (RP). From a population of 570 RP, 263 RP with primary feature were selected according to classical clinical, biological and capillaroscopy criteria. Within this group, apparently primary RP without any objective sign of thoracic outlet were compared with those presenting objective signs of thoracic outlet (ie positive "candlestick manoeuvre", abnormal dynamic Doppler examination). The two groups were compared according to epidemiologic (family history of RP, age of onset, sex), clinical (digital topography of attacks, asymmetry of RP, functional severity, course during summer, circumstances of occurrence) and investigational data (digital plethysmographic cold test). No significant differences were found between apparently primary RP with signs of thoracic outlet and those without signs of thoracic outlet as concerns the parameters usually distinguishing Raynaud's syndrome from Raynaud's disease (family history of vasospasm, sex, asymmetry of RP, thumb involvement, digital vascular reactivity to cold). On the other hand, significant differences are noted for the following parameters: age of onset (p = 0.005), course during summer (p = 0.031), circumstances of occurrence (p = 0.0007), digital topography of attacks (p = 0.004), functional severity (p = 0.044), plethysmographic basal reactivity (p = 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)