THE SUBUNGUAL SUBUNGEAL EXAM knowledge Base o Anatomy of subungual space: Sub-ungual space is a capillary vascular bed seen through transluscent nails. Changes in hemoglobin and vascular bed can be evaluated by the examination of sub-ungual space. o Clinical assessment of cardiac output: We are able to assess the refilling of capillary bed following compression and rease of nail. Rapidity with which it fills is a reflexion of cardiac output. If the circulation time is prolonged and the cardiac output is low capillary filling is prolonged. o Diseases affecting subungual space: Trauma, Bacterial endocarditis, Hereditary hemorrhagic telengiectasia. o The subungual space is pink.Subungual capillary bed blanches on compression and fills immediately on release of pressure. o The light transmission through the nail bed is uniform. o Caution: Nail polish should be removed before the sub-ungual space can be examined. o Delayed capillary filling: (Low cardiac output) o Pallor : (Anemia) o Blue: (Cyanosis) o Longitudinal Red or Brown linear streaks: Subungual hemorrhage (Trauma, SBE, Trichinosis) o Petechiae: (SBE) o Telangiectasia: Blanches on pressure (Osler-Rendu-Weber Syndrome) o Normal nails are translucent, shiny and firm in texture. o Longitudinal bands of pigment can normally be seen in black patients. o With aging nails may lose their luster, thicken and become yellow. o Longitudinal ridging also develops with aging. Abnormal Finding: Abnormalities in color, shape, and texture may reflect: Compress the nail and observe the filling time of the capillaries. Assess the hemoglobin status. Using a flash light under the nail and observe the uniformity of light transmission. Abnormality of nail itself The skin under the nails The periungual area Systemic problem reflected in nail changes • Color o Terry nail: White nail (Liver disease) o Pigmentation: (Chemotherapy) o Transeverse band: • Shape and appearance: o Ridging: (Normal aging) o Pitting: (Psoriasis) o Koilonychia: Spooning. Concave (Iron def anemia) o Onycholysis: (Thyrotoxicosis) o Parrot beaking: Convex curve (Normal, TB patients) o Beaus line: Transverse depressions corresponding to the period of (Acute severe illness) o Merckes line: (Liver disease) o Nail biting: (Anxiety state) o Fungal infection (Onychomycosis) o Psoriasis • Texture o Dry and brittle: (Iron def anemia, fungal infection) Intrephalangeal Joint Exam • Examine the contour of finger with hand firmly pressed on a flat surface. o Hold a finger separately and view it laterally to note the angle between skin and base of nail.. o Elicit fluctuation and feel for sponginess of nail bed. o Observe the periungual skin. o Feel for the posterior edge of nail. • Inspect the finger tips. • Evaluate draping of skin to fingers Normal: • Fingers are uniform in width its entire length, the angle between base of nail and skin is 160 o, posterior edge of nail is not palpable and the nail bed is firm. • Creases in finger tips are evident. • Skin is loosely wrapped around fingers
Posted on: Fri, 07 Mar 2014 03:48:19 +0000
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