The hand is known to frequently present signs or symptoms of generalized or systemic diseases. Because the hand contains structures from the skin, muscular, skeletal, circulatory, and nervous systems, it often provides clues to diseases which are yet to be diagnosed in other parts of the body. Presentation of complaints, lesions, symptoms or signs in the hand may alert the hand surgeon to these systemic diseases. Although the hand surgeon may not treat all of these diseases, he is in a position to help make the diagnosis and refer the patient to a different specialist.
Musculoskeletal diseases may result in enlargement of joints. Arthritis diseases commonly are associated with these abnormailites.
Raynaud’s Phenomenon
Raynaud’s phenomenon (temporary spasm of the arteries in the fingers, resulting in coolness and bluish/purple discoloration (see Figure 1) may occur with rheumatoid arthritis, systemic lupus, and scleroderma, to name a few. If the condition is more severe, fingertip ulcers may result from the poor circulation.
Figure 1: Raynaud’s Phenomenon
Clubbed Nails
The finger nails may develop an unusual clubbed shape (See Figure 2) with some heart or lung diseases.
Buerger’s Disease
Another disease of the blood vessels, Buerger’s disease, affects the small arteries resulting in inadequate blood supply to the fingers. This often results in ulcerations and even gangrene (see Figure 3).
Figure 3: Buerger’s Disease
Rheumatoid Arthritis
Rheumatoid arthritis causes destruction of joints, ligaments and tendons. It can have widespread effects throughout the body. Tendon rupture (see Figure 4) may result in limited ability to straighten a finger(s) and may be one of the first signs of Rheumatoid Arthritis.
Gout
Gout, a disease of uric acid metabolism, may present as a yellowish-white nodule on a digit (see Figure 5). The skin may become thin to the point of draining and thus be confused with an infection, especially if there is an acute, painful attack of the gout. Severe bone changes may exist beneath the skin. In this case, there is also a nail deformity characterized by a severe curvature, called a “pincer nail”. This can cause pain and ingrowing of the nail.
Figure 5 : Gout
Diabetes
Diseases of the hormones (endocrine system), may result in changes of tendon and ligament tissue. Diabetes is a known cause of “trigger finger” (see Figure 6) in which the finger may be temporarily locked in the flexed position often with pain.
Liver & Kidney Diseases
Liver and kidney diseases may also cause changes in the skin and in the nails. Below is an example of discoloration of the nails, called Terry’s Nails (see Figure 7), where most of the matrix under the nail is white. There is a small rim of pink at the matrix near the fingertip. This type of nail change is seen with liver disease.
These are a few of the conditions frequently seen but others include:-
- Heberden’s Node
- Bouchard’s Node
- Dactylitis associated with Psoriatic Arthritis
- Mucos Cyst or Ganglion Cyst
- Dermatomyositis
- Systemic Lupus
- Scleroderma
- Leukonychia
- Muehrche’s Nails
- Splinter hemorrhages as seen in Endocarditis (heart infection)
- Psoriasis
- Alcoholic neuropathy
- Neuropathy associated with blood vessel spasm diseases
- Multiple Sclerosis
Download the PDF on Systemic Diseases
