. Physical diagnosis . Fig. 28.—Tetany. (Masland.) THE HANDS. 47 5. Acromegalia produces general enlargement of the bones andother tissues of the hands and feet. 6. Pulmonary Osteo-arthropathy.—Any long-standing diseaseof the heart, lungs, or pleura may be followed by this peculiar hy-pertrophic change in all the tissues of the extremities. Mild formsproduce clubbed fingers, a bulbous enlargement of the finger-tipswith double curvation of the nails, lateral and antero-posterior (see. FIG. 29.—Atrophic Arthritis with Flipper Hand. Fig. 31). In severer forms the bones of the hand and wrist are a
. Physical diagnosis . Fig. 28.—Tetany. (Masland.) THE HANDS. 47 5. Acromegalia produces general enlargement of the bones andother tissues of the hands and feet. 6. Pulmonary Osteo-arthropathy.—Any long-standing diseaseof the heart, lungs, or pleura may be followed by this peculiar hy-pertrophic change in all the tissues of the extremities. Mild formsproduce clubbed fingers, a bulbous enlargement of the finger-tipswith double curvation of the nails, lateral and antero-posterior (see. FIG. 29.—Atrophic Arthritis with Flipper Hand. Fig. 31). In severer forms the bones of the hand and wrist are alsoconsiderably enlarged (see Figs. 25 and 26). 7. Heberderfs nodes, later described under the head of hyper-trophic arthritis, are here pictured (Fig. 32). The distinctionfrom gout has already been referred to (page 503). 8. Atrophic arthritis (Fig. 29) (further described on page 496)presents its most typical lesions in the hands and wrists. The con-striction line opposite the articulation is observed in late cases, butordinarily multiple spindle-joints symmetrically arranged are all 48 PHYSICAL DIAGNOSIS. that we see. The boggy feel, the trophic disturbances, and thechronic course are diagnostic. 9. Syphilitic and tuberculous dactylitis (see Fig. 33), seen as a
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