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Hand & Wrist Exam

Nail Examination

May 9th, 2019


Examination of the nails may reveal pathognomonic signs suggestive of rheumatologic disease.


  • Look For

  • Separation of the nail from the nail bed, either distally or laterally.
  • Causes of Onycholysis

  • Skin disease - psoriasis, dermatitis, lichen planus
  • Nail infection
  • Trauma
  • Systemic disease - chronic kidney disease, bronchial carcinoma, anaemia, diabetes mellitus, porphyrias, peripheral vascular disease, thyrotoxicosis

Nail Pitting

  • Look For

  • Pin-point depressions in the nail plate.
  • Causes of Nail Pitting

  • Eczema
  • Psoriasis
  • Reactive arthritis
  • Alopecia areata
  • Sarcoidosis

Splinter Haemorrhages

  • Look For

  • Painless longitudinal red / brown lines between 1-3mm on the nail bed.
  • Causes of Splinter Haemorrhages

  • Trauma
  • Infective endocarditis
  • Vasculitis - rheumatoid arthritis, antiphospholipid syndrome, systemic lupus erythematosus, Behcet disease
  • Skin conditions - psoriasis, lichen planus
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