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This article provides a brief overview of signs that may be found on the hands during clinical examination.
Splinter haemorrhages are caused by small emboli becoming lodged in nailbed capillaries causing secondary haemorrhage.
Psoriatic nail disease
Osler’s 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.
Janewaylesions 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 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
Finger clubbing involves uniform soft tissueswelling of the terminalphalanx of a digit with subsequent loss of the normal angle between the nail and the nail bed.
Finger clubbing is associated with several underlying disease processes including:
Congenital cyanotic heart disease
Inflammatory bowel disease
Asterixis (also known as ‘flapping tremor’) is a type of negative myoclonus characterised by irregular lapses of posture causing a flapping motion of the hands.
Causes of asterixis include:
CO2 retention (e.g. COPD)
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.
Nail pitting involves punctate depressions of the nail plate.
It is most commonly associated with psoriasis.
Dupuytren’s contracture is a benign and progressive disorder of the hand. It involves the development of cords within the palmar fascia leading to 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:
Excessive alcohol intake
Manual work: especially involving 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 a hereditary component
Palmar erythema refers to redness involving the heel of the palm.
Chronic liver disease
Adapted by Geeky Medics. Roberto J. Galindo. Osler’s nodes. Licence CC BY-SA.
Adapted by Geeky Medics. Warfieldian. Janeway lesions. Licence: CC BY-SA.