Look at your hand

Look at your Hand

PKGhatak,MD

Examination of hand

Many centuries ago, people were just as interested in their future as we are today. By observing the difference in the appearance of hands, for example, a manual laborer's coarse palm, and the well-kept nails of an artist, one can tell the profession of a person. The process of observation and deduction continues today. We can find out a lot by an examination of a hand.

Occasionally people have an extra finger, often tiny and deformed, attached to the side of the hand or have a double thumb known as polydactyly; at times two adjacent fingers are joined together by a loose fold of skin called syndactyly. In rare cases, individuals have hands that resemble the claws of lobsters. These are congenital conditions.

In Thalidomide-children the lower arm and hand may be absent altogether or maybe rudimentary because the mothers of these individuals were exposed to thalidomide during early pregnancy.

The hitting hand of a boxer is called a “dropped knuckle” if he has a fracture of the neck of a bone connecting the wrist to the finger (Metacarpal). A “baseball hand” means a severed extensor tendon of the throwing arm; a “boutonniere deformity” means a split of ligaments over the proximal finger joint. The absence of normal fullness in between the thumb and the index finger is due to an ulnar nerve injury. The inability to extend fingers and the lumpy feeling over the tendons in the palms of heavy machine operators is known as Dupuytren's contracture. Extensive loss of muscles of the back of hands giving the appearance of a claw hand may be due to an injury to the ulnar nerve or ALS.

Both degenerative arthritis and rheumatoid arthritis deform finger joints, and each one has its characteristic pattern. Splinter like bleeding under the tip of nail beds or raised, reddish and tender bumps called Osler’s nodules are seen in the infection of the inner lying of the heart. Bulbous deformed tips of fingers may resemble drumsticks called clubbing of fingers seen in certain serious lung or intestinal diseases; hollowed out nail beds resembling spoons are seen in malnutrition. Blue nail beds on cold days may not be important but on a warm day or if blue nails are associated with clubbed fingers indicate the presence of a hole in the partition wall of heart chambers or a deformed heart valve. Spider like tiny collections of pink blood vessels on the backs of hands are seen in liver cirrhosis.

Disease conditions can produce characteristic changes -

Melanoma - dark steak along the length of the nail. 

Onycholysis - nails lift from the nail bed and areas look white in cases of fungal infection, Psoriasis, splinters under the nail, or aggressive cleaning with a sharp object underneath the nail.

Paronychia - infection of soft tissue around the nail results in pain, swelling, and redness. In case the color is blue then it is due to a pseudonymous bacteria infection.

Pitting - psoriasis, atopic dermatitis, alopecia areata.

Yellow nail syndrome - slow growing, thick yellow nails due to chronic lung disease and Rheumatoid arthritis.

Onychogryphosis or Ram's horn nails - thick overgrown nails in the shape of horns. Seen in psoriasis, circulatory insufficiency, ichthyosis.

Beau lines - deep grooves across the width of the middle of the nail from stress, chemotherapy and serious illness.

Koilonychia - spoon shaped nails are seen in iron deficiency, celiac disease, high altitudes.

Onychotillomania - habits of pushing the cuticle back repeatedly cause ridges and grooves in the center of the nail.

Color changes - White from liver cirrhosis. Pale from anemia.  Yellow from chronic infection. Half white & half pink from chronic renal failure. Dusky reddish half-moon shaped - Dermatomyositis, Lupus erythematosus, Alopecia areata.

This list is far from complete. You will agree that a careful examination of the hand one can tell a lot.

 

 

revised 2020.