I f a patient has painful wrists, painful ankles and comes to see you and you miss that they also have clubbing, you will go down the wrong path looking for RA etc, when what they have is Hypertrophic Pulmonary Osteoarthropathy. The causes of HPOA are the same as those of clubbing. Examining the nail for indication of different disease is a part of the art of physical examination. Let us see how nail can help diagnosing disease. Terry's Nails Proximal paleness extending halfway up the nail, often eliminating lunula. Darker distal band.
Seen in states of stress (e.g. advanced age, liver disease/cirrhosis, CHF, DM2). Lindsay's Nails (Half-and-half Nails) Distal brown transverse band seen in kidney disease. Caused by increased pigment deposition. Beau's Lines Transverse depressed ridges seen in severe infection, MI, hypotension/shock, hypocalcemia, post-surgical, malnutrition and with…
