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This article provides a brief overview ofย signs that may be found on the hands during clinical examination.
Splinter haemorrhages
Splinter haemorrhages are caused by small emboli becoming lodged in nailbed capillaries causing secondary haemorrhage.
Causes include:
- Local trauma
- Infective endocarditis
- Sepsis
- Vasculitis
- Psoriatic nail disease
Osler’s nodes
Oslerโs nodes are red-purple, slightly raised, tender lumps that often have a pale centre. These lesions are typically found on the fingers or toes and are associated with infective endocarditis.
Janeway lesions
Janeway lesions are non-tender, haemorrhagic lesions that occur on the thenar and hypothenar eminences of the palms and soles. Janeway lesions are typically associated with infective endocarditis.
Fingertip pallor
Fingertip pallor refers to a white and waxy appearance that occurs as a result of vasoconstriction or vascular obstruction.
Conditions associated with this sign include:
- Peripheral vascular disease
- Raynaudโs phenomenon
- Buergerโs disease
- CREST syndrome
Causes of finger clubbing
Finger clubbing involvesย uniform soft tissueย swellingย of theย terminalย phalanxย of aย digitย with subsequentย loss of the normal angleย between theย nailย and theย nail bed.
Finger clubbing is associated with several underlying disease processes including:
- Congenital cyanotic heart disease
- Infective endocarditis
- Atrial myxoma
- Bronchiectasis
- Lung cancer
- Cystic fibrosis
- Inflammatory bowel disease
Asterixis
Asterixisย (also known as โflapping tremorโ) is a type of negative myoclonus characterised by irregular lapses of posture causing a flapping motion of the hands.
Causes of asterixis include:
- CO2ย retentionย (e.g. COPD)
- Uraemia
- Hepatic encephalopathy
Xanthomata
Xanthomata are raised yellow cholesterol-rich deposits that are often noted on the palm, tendons of the wrist and elbow.
Xanthomata are associated with hyperlipidaemia (typically familial hypercholesterolaemia), an important risk factor for cardiovascular disease.
Leukonychia
Leukonychia involves whitening of the nail bed.
Causes include:
- Nailbed trauma
- Hypoalbuminaemia (e.g. end-stage liver disease, protein-losing enteropathy)
- Chemotherapy
Koilonychia
Koilonychia refers to spoon-shaped nails.
Causes include:
- Iron deficiency anaemia (e.g. Crohnโs disease)
- Lichen planus
- Rheumatic fever
Nail pitting
Nail pitting involves punctate depressions of the nail plate.
It is most commonly associated with psoriasis.
Dupuytren’s contracture
Dupuytrenโs contracture is aย benign and progressive disorder of the hand. It involves the development ofย cordsย within theย palmar fasciaย leading toย contracture and flexion deformity, often localised to the ring finger.
Although a specific cause has not been established, a number of risk factors have been identified:
- Excessiveย alcoholย intake
- Manual work: especially involvingย vibrational machinery
- Smoking: smokers are 3 times more likely to develop the condition
- Diabetes mellitus: 1 in 5 diabetic patients develop the condition
- 70% of patients have aย hereditaryย component
Palmar erythema
Palmar erythema refers to redness involving the heel of the palm.
Causes include:
- Chronic liver disease
- Pregnancy
- Hyperthyroidism
References
- Adapted by Geeky Medics. Roberto J. Galindo. Oslerโs nodes. Licenceย CC BY-SA.ย
- Adapted by Geeky Medics. Warfieldian. Janeway lesions. Licence:ย CC BY-SA.ย
- Intermedichbo [CC BY-SA 3.0] via Wikimedia Commons
- Adapted by Geeky Medics. Desherinka. Finger clubbing. Licence:ย CC BY-SA.ย
- Adapted by Geeky Medics. Min.neel. Xanthoma in a child. Licence:ย CC BY-SA.
- Adapted by Geeky Medics. BrotherLongLegs. Leukonychia. Licence:ย CC BY-SA.ย
- Adapted by Geeky Medics. CHeitz. Koilonychia. Licence:ย CC BY 2.0.ย
- Seenms. Adapted by Geeky Medics. Nail pitting. Licence:ย CC BY-SA.ย
- Adapted by Geeky Medics. Frank C. Mรผller. Dupuytrenโs. Licence:ย CC BY-SA.ย