Pathology of the cervical lymph nodes (lymphadenopathy)

DEFINITION: Cervical lymphadenopathy or a pathology affecting the lymph nodes located in the cervical or neck region. There are various groups or chains of lymph nodes mostly located along the lateral borders of the neck. There are about 300 lymph nodes in this region. There are various methods of grouping and naming them. There superficial […]

Pathologies of the axillary lymph nodes

NAME OF CONDITION: Pathology of the axillary lymph nodes (lymphadenopathy) DEFINITION: Axillary lymphadenopathy is a general term implying a pathology or abnormality affecting the axillary lymph nodes. CAUSES: The axillary lymph nodes are arranged in various groups and are located around and inside the axilla or armpit. They drain the external thoracic wall, the breasts […]

Inguinal Lymph Nodes

Definition: The deep inguinal lymph nodes are not palpable. However the superficial (palpable) are divided into two groups, the horizontal and the vertical. The horizontal nodes drain portions of the lower abdomen, the buttocks, the anal canal and peri-anal areas. The lower vertical nodes drain the vagina and external genitalia. The vertical nodes drain the lower […]

Beau’s Lines

Definition:Beau’s lines are deep transverse grooves on the surface of the nails. The groove demarcates a difference in the appearance of the nail. In practice, Beau’s lines are a common observation and a sign of non-specific disease processes. Causes: Beau’s lines may appear several weeks or months following a protracted systemic illness, high fever, infections, […]

Parkinson’s Disease

Definition: Degenerative disease affecting the basal ganglia causing increasing bradykinesia and rigidity with associated tremor and instability. Causes: Idiopathic. Cause remains unknown but there are possible familial links. Dopaminergic neurons in substantia nigra are depleted and Lewy bodies are present, and other atrophic changes. Decreased dopamine production reduces inhibition of cells which become more active […]

Rheumatoid arthritis

Definition: Inflammatory, seropositive, autoimmune joint disease.  Causes: Chronic joint inflammation due to autoimmune cell activation and formation of immune complexes in joints. Joint destruction is gradual due to chronic inflammation and swelling. Examination: Disease progression can be insidious at first, beginning with non-specific joint tenderness and stiffness due to inflammation; especially morning stiffness/pain lasting over […]

Raynaud’s phenomenon

Definition: Painful sequence of changes in fingers due to vasospasm (pallor), cyanosis and redness (hyperaemia). Can be primary or secondary. Causes: Primary Raynaud’s (Raynaud’s disease) is idiopathic and typically affects young women. It is triggered by cold or emotional stimuli. There is often a family history of the condition. Secondary Raynaud’s (Raynaud’s syndrome) affects older […]

Nail Pitting

Definition: Small indentations in the nail. Causes: Most commonly observed in psoriasis, especially psoriatic arthritis. Can also be seen in alopecia areata. Examination: A small amount of pitting in nails can be idiopathic and of no clinical importance. Nail pitting can be a key sign of psoriatic arthritis with little skin involvement observable. Observe nails […]

Paronychia – Inflammation of the nail fold

Definition: Inflammation of the nail fold. Causes: Infection of the nail fold precipitates tenderness, pain, redness, swelling and discharge. Non-tender swelling of nail fold can be caused by Candida. Examination: Observe nail fold for redness, swelling or any discharge. Ask about occupation. Hands often immersed in water are more susceptible to Candida. Nail biting can […]

Heberden’s & Bouchard’s nodes – Osteoarthritis

Definition: Heberden’s nodes are osteoarthritic nodules of the distal interphalangeal joints (DIPs). Bouchard’s nodes are osteoarthritic nodules at proximal interphalangeal joints (PIPs). Causes: Due to formation of osteophytes on interphalangeal joints in osteoarthritis. Examination: Examine patient’s hands carefully, specifically the interphalangeal joints. Nodules are generally a few millimetres in diameter. Both nodes are usually painless. […]

Osler’s Nodes

Definition: Painful, small, palpable  mauvish nodules on finger pads, palms and soles of feet. Causes: In endocarditis, septic emboli can cause small cutaneous abscesses. Examination: One of number of peripheral stigmata which are sometimes seen in patients with endocarditis. Observe finger pads and palms. If lesions are present, enquire if they are painful. Janeway lesions […]

Onycholysis – Separation of the nail from the nailbed

Definition: Separation of the nail from nail bed. Causes: Observed in psoriasis (also pitting of nails), hyperthyroidism, nail mycoses (fungal infection), trauma and iatrogenic (tetracycline therapy). Examination: Examine the patient’s hands carefully. Onycholysis is characterised by proximal separation of nail from nail bed. This allows debris to collect under the nail which is inaccessible to […]

Koilonychia or Spoon-shaped (concave) Nails

Definition: Spoon-shaped or concave nail growth. The nail may also have raised longitudinal ridges and may be thin or brittle. Causes: Iron deficiency anaemia may cause thin, brittle and/or ridged nail appearance. Koilonychia typically appears as concave nail growth and may present also as flat nail growth. Examination: Examine the patient’s hands carefully. In long […]

Finger/Nail Clubbing

Definition: Also referred to as: Hippocratic fingers and Digital Clubbing. Clubbing is the pathological thickening and broadening of the soft tissue surrounding the terminal phalanx under the nails. The nails also become curved both longitudinally and laterally. Clubbing is present if there is: Increased nail bed fluctuance, loss of normal nail bed/nail angle (loss of […]

Dupuytren’s contracture

Definition: Fibrosis (thickening) with subsequent contraction of palmar fascia causing fixed flexion of ring and little finger. Causes: Precise cause of fibrosis is unknown but risk factors include: cirrhosis, alcoholism and diabetes mellitus. Examination: Observe both patient’s hands for skin colour, swelling and deformity. Presentation of Dupuytren’s is usually bilateral but one hand is often […]

Cushing’s Syndrome

Definition: Hyperandrenocorticism: Endocrine disorder characterised by excess corticosteroids. Causes: Iatrogenic (exogenous) cause most common, secondary to long-term glucocorticoid therapy. Syndrome more rarely due to excess endogenous adrenocorticotropic hormone (ACTH) from adrenal or pituitary tumour. Examination: Typical presentation is central obesity; ‘lemon on sticks’ appearance with moon face. Other physical signs and symptoms include: excessive sweating, […]