Handshake with the patient may clinch some clinical diagnosis:
Warm and moist hand—thyrotoxicosis, type II respiratory failure
Cold and moist hand—anxiety neurosis
Cold and dry hand—myxoedema
Cold and clammy hand—shock (may be with peripheral cyanosis)
Patient not releasing (slow relaxation) examiner’s hand—myotonia
Painful shaking hand—rheumatoid arthritis, hand injury, gout.
Others:
Palmar erythema—cirrhosis of liver, chronic alcoholics, thyrotoxicosis, pregnancy,
high pyrexia.
Colour changes (in palm)—yellow in jaundice, pale in anaemia (especially palmar
creases), orange-yellow in carotenaemia, blue in cyanosis (especially tips of fingers
and nail-beds), or triphasic colour response in Raynaud’s phenomenon (e.g.,
scleroderma).
Clubbing—vide the section on ‘Clubbing’.
Both clubbing and cyanosis—cyanotic congenital heart disease, fibrosing alveolitis,
bilateral extensive bronchiectasis, cystic fibrosis.
Wasting of small muscles of hand—leprosy, motor neuron disease
(MND), syringomyelia, long-continued rheumatoid arthritis.
Capillary pulsation and digital artery pulsations—aortic iregurgitation, hyperkinetic
circulatory states (severe anaemia, thyrotoxicosis).
Tremor—different types like static, action, intention, or flapping tremor.
Swellings—Osler’s node (e.g., SBE), Heberden’s and Bouchard’s node over dorsal
aspect of distal interphalangeal (DIP) and proximal interphalangeal (PIP) joints
respectively in osteoarthritis, gouty tophi or calcinosis (e.g., scleroderma), Gottron’s
papules (lilac-coloured papules over knuckles seen in dermatomyositis); oedema
over dorsum of hands is seen after IV drip inserted over veins in dorsum of hand,
or as a part of anasarca; a large finger may be due to local arteriovenous malformations
Deformities—they are swan-neck deformity, button-hole deformity or Z-deformity
of thumbs are common in rheumatoid arthritis , Dupuytren’s contracture
(painless flexion contracture of ring and little fingers may be due to alcoholic
cirrhosis, diabetes, repeated trauma to palm or after phenytoin therapy),
carpopedal spasm in tetany, short 4th metacarpal bone in pseudohypoparathyroidism
and Turner’s syndrome, polydactyly in Laurence-Moon-Biedl syndrome,
fingerisation of thumb in Holt-Oram syndrome, arachnodactyly (long slender
fingers) in Marfan’s syndrome, sclerodactyly in scleroderma, syndactyly
(two or more fingers are fused together) in Apert syndrome, clinodactyly (incurved
little finger) in Down’s syndrome, and spade-shaped hand in acromegaly.
Arteriovenous malformations may give rise to a larger hand than the normal side.
Claw hand—in claw hand, the martacarpophalangeal (MCP) joints are
hyperextended, and PIP and DIP joints are flexed due to T1 segment lesion or lesion
in both ulnar and median nerve. It is commonly seen in leprosy, MND, thoracic
inlet syndrome, syringomyelia or cervical rib.
Nail changes—vide the section on ‘Skin, hairs and nails’.
Pigmentary changes—vide the section on ‘Skin, hairs and nails’.
Miscellaneous—pulp atrophy, nail-fold thrombi, digital infarction/ulceration/
gangrene are features of vasculitis, e.g., in SLE, or scleroderma , single
palmar crease in Down’s syndrome, nicotine staining in right index and middle
finger in chronic smoker, palmar xanthoma in familial hyperlipidaemia, petechiae/
purpura/ecchymosis in haemorrhagic disorders, wrist drop in radial nerve palsy,
or itchy drug rash over dorsum of hands.