Hands

Findings on Hand Examination
Component Inspection Palpation Percussion
General
Respiratory
  • Nicotine staining
  • Intraosseous muscle wasting
  • Clubbing
Cardiovascular
  • Stigmata of IE
    • Janeway lesions
    • Osler’s nodes
    • Splinter haemorrhages
  • Clubbing
Neurological
Endocrine and Metabolic
Renal
Gastrointestinal
  • Clubbing
Haematological
Integumentary
  • Dupuytren’s contracture
Trauma
Infective
  • Lymphadenopathy
Malignant
Toxic
Immune
  • Lymphadenopathy
Congenital
Obstetric

Features

Respiratory

  • Nicotine staining
    Indicative of smoking.
Nicotine Staining

  • Clubbing
    Loss of the nail bed angle and soft tissue swelling at the tips of the digit.

The normal nail bed angle is <140–160°, and is (was?) known as the Lovibond angle.

  • Janeway lesions
    Red-purple, non-tender, haemorrhagic lesions on the palms and soles associated with septic microembolism, particularly S. Aureus endocarditis. Typically last days-weeks.
Janeway Lesion

  • Osler’s nodes
    Tender, raised red-purple lumps, usually with a pale centre, and associated with septic microembolism, classically bacterial endocarditis. Typically last from hours to a few days.
Osler’s node

  • Splinter haemorrhage
    Longitudinal, red-brown haemorrhage under the finger nail. Associated with:
    • Trauma
    • Endocarditis
    • Meningococcal infection
    • Histoplasmosis
Splinter Haemorrhage

References

  1. Foot C, Steel L, Vidhani K, Lister B, MacPartlin M, Blackwell N. Examination Intensive Care Medicine. Elsevier Australia; 2011. (Examination series).
  2. Dünser MW, Dankl D, Petros S, Mer M. Clinical Examination Skills in the Adult Critically Ill Patient. Springer International Publishing; 2018.