Diagnosis, Pathology, and Management of Pain in the Ischemic Hand: A Comprehensive Review.

Berns, Ellis; Zhuang, Thompson; Ohlsson, Anna H; Lee, Hannah H · J Hand Surg Am · 2026

review · Level V

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Abstract

Chronic limb-threatening ischemia of the upper extremity, resulting from pathologies like vasospasm, occlusion, trauma, or end-stage renal disease, is challenging to manage because of severe pain and morbidity. This review seeks to summarize the vascular anatomy of the upper extremity at risk for chronic limb-threatening ischemia, explain the pathophysiology of ischemic pain signaling, review diagnostic testing, and explore medical and surgical pain management options, as well as introduce avenues for future research.

Anatomy