The Hands May Hold the Key to Diagnosis: A Photo Quiz

March 26, 2014

Patients frequently present with hand disorders, and the hands often show changes that reflect a disease that affects other parts of or the whole body. This week’s photo quiz offers several presentations to test your knowledge.

Question 1:

Evaluation of hand wounds often is complicated by injury to the tendons and nerves that run fairly close to the surface. A big part of the evaluation is checking for tendon lacerations by assessing tendon function. To check for a partial tendon laceration, test the strength of the injured finger: apply firm pressure to the distal phalanx with the corresponding phalanx of your dominant hand while instructing the patient to resist.

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Question 2:

In the prayer sign, the patient is asked to put his or her hands together in a praying position with the fingers fanned and to press together the palmar surfaces of the interphalangeal joints and the palms.

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Question 3:

This patient, a 45-year-old African American man, presented with heart disorders and congenital hand deformities. Congenital deformities of the hands are common. A small group of these deformities are associated with congenital disorders of the heart. Some of the hand-heart abnormalities are inheritable.

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Question 4:

Arm and hand edema are clinical signs of deep vein thrombosis (DVT), with associated tenderness, erythema, and warmth. Left subclavian-axillary vein thrombosis occurred in this patient after central line placement. Primary thrombosis accounts for 20% of upper extremity DVT. The other 80% of cases result from secondary means, distruption of 1 or more of the components of Virchow triad.

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Question 5:

A 41-year-old woman had pain in the pulp of her fingers and dorsa of her feet. A purplish red maculopapular lesion was noted on the pulp of her finger and was identified as an Osler node.

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Question 6:

Lymphedema, seen here in the right hand and arm of a female patient after axillary lymph node dissection, results from accumulation of proteinaceous fluid in interstitial tissue; with time, there is inflammation and fibrosis of subcutaneous tissue. Slowed lymphatic transit time induces lipogenesis and fat deposition. Fibrocytes are then activated and, with time, connective tissue overgrowth occurs as fibrosis ensues.

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ANSWER KEY:

Question 1. D

Question 2. B

Question 3. C

Question 4. D

Question 5. D

Question 6. C