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42 m a s s a g e & b o d y w o r k m a r c h / a p r i l 2 0 1 7 or having some obstruction to blood or nerve flow (like carpal tunnel syndrome) can all lead to Raynaud's phenomenon. Other factors. A history of trauma to the extremities may be another contributor to problems with vasomotor responses. If a person has ever had frostbite or surgery to the hands or feet, the risk of Raynaud's goes up. A handful of other situations may also contribute to the risk of Raynaud's phenomenon, including some blood disorders, thyroid problems, and pulmonary hypertension. Raynaud's phenomenon is usually much more severe than primary Raynaud's disease, and it carries a risk for structural changes that can lead to severe damage in the skin on the extremities, including ulcerations and the possibility of gangrene. It usually affects the fingers, but it could also involve the toes or ears. Some of the early structural changes can involve capillary deformation at the nail beds. This is easily observable with simple laboratory tests, and it is an early indicator of Raynaud's phenomenon. In addition to deformed capillaries in the fingertips, new technology shows that people with Raynaud's phenomenon show three interesting variances from the norm: they have a deficiency of local vasodilators (so vasoconstriction is unopposed and extreme); they may have some abnormal brain stem function that fails to integrate cardiovascular responses with stress—this also leads to impaired dilation and enhanced constriction; and they show unusually high levels of platelet activation. These discoveries may seem abstract, but they could lead to new strategies for treatment, so they could be important for people who struggle with this condition. SIGNS AND SYMPTOMS We have already discussed the prevailing signs and symptoms of Raynaud's syndrome. A typical episode begins with a sudden onset of extreme vasoconstriction, usually in parts of the fingers or toes. Triggers may be exposure to cold temperatures, or stress, or both. The vasoconstriction is so severe that the skin may develop patches of grey or white, and then a bluish tone takes over—this is cyanosis, literally "condition of blueness"—as the cells are starved of oxygen. When the vasoconstriction releases, it is often followed by extreme vasodilation and a bright red flush over the previously blue areas. The main symptoms of Raynaud's syndrome have to do with color change and the sensation of cold; but tingling, throbbing, numbness, and burning pain are often also part of the picture. Raynaud's syndrome episodes can last anywhere from a minute or two to several hours, and they happen with unpredictable frequency. As long as the skin is healthy and intact, massage for this condition is not only safe, it is probably a really good idea— both for stress reduction and for localized blood f low.