Upper Extremity Arterial Testing: The Diagnostic Criteria for the Physiologic Examination

Abstract

Upper extremity arterial disease is relatively uncommon compared with lower extremity disease, but presents a unique diagnostic challenge for physicians and technologists. It affects approximately 5–10% of the population. The most common causes of upper extremity arterial disease are atherosclerosis and embolic disease. Some common symptoms of upper arterial disease include dysesthesia, paresthesia, pallor, cold intolerance, ulceration, pain, or weakness in one or both extremities. The vascular system plays a vital role in the delivering of nutrients and clearing metabolic waste products from the peripheral tissues and also helps maintain an individual's systemic core temperature. In a majority of patients, the deep and superficial palmar arches provide the dominant blood supply to the hand. The arches are a continuation of the radial and ulnar arteries. These arches are typically connected in approximately 80% of patients. In order to accurately diagnose upper extremity arterial disease, a noninvasive upper extremity physiologic examination is of importance to determine treatment options for patients. The physiologic examination includes upper extremity segmental pressures known as wrist-brachial index, Doppler waveforms; digital evaluations include photoplethysmography and pressures of the digits known as the digital-brachial index. Physiologic tests are indirect examinations. The upper extremity arterial physiologic examination is always completed bilaterally in order to determine if the disease is present in one or both extremities and also assists in the diagnosis of disease severity. The vascular physiologic examination should focus on the symptoms presented by the patient during the history. However, a complete vascular examination is appropriate given the diffuse nature of the atherosclerotic disease process.