Patients may occasionally present to the clinic with an ongoing attack of RP, thereby allowing a definitive diagnosis. Induction of an attack in the physician’s office by submergence of hands in an ice water bath is frequently unsuccessful, seldom necessary, and sometimes dangerous.
The physical examination in primary RP is normal. The real goal in patients with RP is to discern the presence or absence of findings attributable to an underlying condition associated with secondary RP. A careful search for evidence of an underlying rheumatologic disease is required. Abnormal peripheral pulses or asymmetric involvement may suggest peripheral vascular disease, thromboembolic disease, or thoracic outlet syndrome (consider performing an Adson’s test; see Chapter 64 : Entrapment Neuropathies). Puffy hands, tendon friction rubs, sclerodactyly, and telangiectasia suggest scleroderma or its variants. NCM is a useful technique in the evaluation of rheumatologic disease and should be performed.
