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9/19/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 1
The hands
Photographs kindly supplied by:
http:...
9/19/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 2
Inspection
 Movement
 Tremor
 Flap
 Skin Te...
9/19/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 3
Clubbing
Loss of angle between the nail bed and...
9/19/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 4
Beau’s lines
Transverse non-pigmented grooves
A...
9/19/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 5
Koilonychia
Spoon-shaped depression of the nail...
9/19/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 6
Splinter haemorrhages
Asymmetrical, splinter- l...
9/19/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 7
Half-and-half nails
Distal red or brown
band
Pr...
9/19/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 8
Pitting
Small indentations in the nail surface,...
9/19/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 9
Onycholysis
Separation of the free end of the n...
9/19/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 10
Pincer
Transverse overcurvature of the nail, c...
9/19/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 11
Some other examples of nail changes
Nail sign ...
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Basic Examination of the Hands

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Basic Examination of the Hands

  1. 1. 9/19/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 1 The hands Photographs kindly supplied by: http://www.dermnet.com
  2. 2. 9/19/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 2 Inspection  Movement  Tremor  Flap  Skin Texture  Dermatitis  Scarring  Swelling/thickening  Callosities  Dupuytrens contracture  Skin colour  Cyanosis  Pallor  Erythema  Nicotine staining  Nails
  3. 3. 9/19/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 3 Clubbing Loss of angle between the nail bed and the finger May be a feeling of sponginess of the proximal nail bed Causes:  lung cancer  chronic suppurative lung disease  infective endocarditis  cyanotic heart disease  cirrhosis of the liver  inflammatory bowel disease  congenital http://www.dermnet.com
  4. 4. 9/19/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 4 Beau’s lines Transverse non-pigmented grooves Associated with arrested nail growth  Post fever, weight loss, acute severe illness http://www.dermnet.comm
  5. 5. 9/19/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 5 Koilonychia Spoon-shaped depression of the nails, caused by  Iron deficiency (may be congenital) http://www.dermnet.comm
  6. 6. 9/19/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 6 Splinter haemorrhages Asymmetrical, splinter- like lesions, caused by:  trauma (usually along junction between free edge and nail bed) this is commonest cause  Infective endocarditis,  vasculitis, http://www.dermnet.comm
  7. 7. 9/19/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 7 Half-and-half nails Distal red or brown band Proximal nail white or pink Caused by:  Chronic renal failure, chronic liver disease http://health.allrefer.com/pictures-images/half-and-half-nails.html
  8. 8. 9/19/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 8 Pitting Small indentations in the nail surface, caused by:  Psoriasis (nails often have multiple pits of 20 or more) http://www.dermatlas.org/derm/result.cfm?Diagnosis=-946037564
  9. 9. 9/19/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 9 Onycholysis Separation of the free end of the nail from the underlying nail bed, caused by:  Psoriasis,  fungal infections,  thyrotoxicosis http://www.dermnet.comm
  10. 10. 9/19/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 10 Pincer Transverse overcurvature of the nail, caused by:  Degenerative osteoarthritis of distal interphalangeal joints  Ill fitting shoes  Subungual exoxtosis  Fungal infection http://www.dermnet.comm
  11. 11. 9/19/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 11 Some other examples of nail changes Nail sign Description Some causes Onychomycosis Thickened, crumbling nail Fungal infections Pale nail bed Anaemia Leuconychia White nails Hypoalbuminaemia Blue nails Cyanosis

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