OSCE Clinical skills - Examination of hand
This is a non-exhaustive list of some clinical signs helpful for pediatric clinical examination and OSCE station. The elicitation or identification of clinical signs is an important part of OSCE examination as well. This post focuses on clinical signs related to hands, palms, and nails.
Clinical signs of Nail - Clubbing
Clubbing is a characteristic bulging of the distal finger and nail bed.
How to measure finger clubbing
The ratio of the anteroposterior diameter of a fingernail to that at the distal inter-phalangeal joint is a simple measure for diagnosing clubbing. This can be obtained by clippers.
If the ratio is more than one - clubbing is present.
Schamroth sign is used for detecting any evidence of clubbing in the child. Asked the child or help him to place the nails of the right and left index fingers against each other.
Normally a diamond-shaped gap is seen between the margin of the nails. In an infant or a child with clubbing, this gap is not visible for the obvious reason as the nail beds are full.
Stages of clubbing are
- Softening of the nail bed, causing a spongy feeling when the nail is pressed
- Loss of the normal < 165° angle between nail bed and fold
- Convex nail growth
- Thickening of the distal part of the finger
- Shine and striation of the nail and skin
Mechanism of clubbing
- Normal pulmonary circulation disruption
- Megakaryocytes not broken into fragments
- Platelet growth factors released
- The proliferation of muscle cells and fibroblasts
- Bronchogenic carcinoma
- Pleural tumors
- Cystic fibrosis
- Pulmonary fibrosis
- Hypertrophic pulmonary osteoarthropathy (HPOA)
- Cyanotic heart disease
- Inflammatory bowel disease
- Liver disease
- Coeliac disease
- Infective endocarditis
- Thyroid disease
- Clubbing is always pathological
- Absence does not exclude underlying disease
Other Clinical signs of nail
Clinical signs of palm
More on Clinical OSCE
Ajay Agade | DNB(Pediatrics), FNB(Pediatric Intensive Care), Fellowship in Pediatric pulmonology and LTV
Ajay is a Paediatric Intensivist, currently working in Pediatric Pulmonology & LTV at Great Ormond Street Hospital NHS, London