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Necrotizing fasciitis of the hand is a rare clinical entity, frequently with devastating functional consequences. A case of necrotizing fasciitis of the thumb and thenar eminence caused by Group A Streptococcus is reported and the management of this condition in the upper limb discussed.

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With the use of a multifinger photoplethysmography system, finger systolic blood pressures were measured before and after cooling in patients with Raynaud's disease. In 30 patients with arteriographically documented arterial obstructions, significantly low digital pressures were found in 91% of fingers with cold sensitivity. In this group of patients a mean decrease in finger pressure of 12.3% occurred during cooling. In a group of 32 patients with Raynaud's phenomenon from unknown causes (primary Raynaud's disease) normal finger pressures were found in 147 (97%) of 152 fingers with cold sensitivity. However, in patients with primary Raynaud's disease, significant lowering of finger pressures was observed after cooling, with an average maximal decrease of 59.2%. The multifinger photoplethysmography method promises to be a reliable instrument for objective measurement in patients with Raynaud's phenomenon.

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Dissection of the subclavian artery usually occurs as a result of trauma, endovascular interventions or connective tissue disorders. Only rarely has it been described occurring spontaneously. The treatment can be endovascular, open surgery, conservative or a combination of the above. There are no guidelines. The best approach is the one tailored to the lesion itself. This case presents a 73-year-old man with a tiresome and heavy feeling in the right arm. He was diagnosed having a spontaneous dissection of the right subclavian artery, accompanied by a complete occlusion more distally. Because of the relatively minor symptoms he was treated conservatively using anticoagulants. After 6 months of treatment there was complete revascularisation with good pulsations at the right wrist.

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