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Text
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URL Address
<a href="http://doi.org/10.1136/ard.2004.021303" target="_blank" rel="noreferrer noopener">http://doi.org/10.1136/ard.2004.021303</a>
Pages
286–290
Issue
2
Volume
64
Dublin Core
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Title
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The often overlooked digital tuft: clues to diagnosis and pathophysiology of neuropathic disease and spondyloarthropathy.
Publisher
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Annals of the rheumatic diseases
Date
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2005
2005-02
Subject
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*Foot Bones/pathology; Adult; Alcoholism/complications; Arthropathy; Bone/etiology; Diabetes Mellitus/pathology; Diagnosis; Diaphyses/pathology; Differential; Female; Fractures; Humans; Leprosy/diagnosis/pathology; Male; Middle Aged; Neurogenic/*diagnosis/etiology/pathology; Neurosyphilis/diagnosis/pathology; Scleroderma; Spondylarthropathies/*diagnosis/pathology; Stroke/complications; Systemic/diagnosis
Creator
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Rothschild B M; Behnam S
Description
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OBJECTIVE: To assess diagnostic implications of abnormalities of the pedal digital tufts and to identify features to facilitate distinguishing of spondyloarthropathy and leprosy. BACKGROUND: Better criteria for distinguishing between these disorders are necessary if their character, natural history, and evolution are to be understood. METHODS: Pedal x rays of 91 consecutive patients with diabetes, 21 alcoholic patients, 100 with spondyloarthropathy, 8 with scleroderma, and 137 with leprosy, and 188 defleshed skeletons of individuals with alcoholism, syphilis, cerebrovascular disease, and paraplegia from the Terry and Hamman-Todd collections were examined for evidence of osseous and articular pathologies. Digital tuft abnormalities were divided into irregularity, divot, flattening, resorption, whittling, and fragmentation. RESULTS: Tuft divots were more common in alcoholics than in diabetic, and were more common in both than in the other groups studied. Tuft flattening was limited to alcoholic and neurosyphilis groups. Tuft whittling was especially prominent among individuals with spondyloarthropathy, contrasted with leprosy and diabetes. Aligned fractures were more common in diabetics than individuals with leprosy. Misaligned fractures were limited to individuals with leprosy and neurosyphilis. Leprosy and spondyloarthropathy were complicated by phalangeal and metatarsal whittling more commonly than other diseases studied. Background pedal abnormalities, derived from individuals with cardiovascular syphilis, cerebrovascular accidents, and paraplegia, was limited to abnormal divots only. CONCLUSIONS: Pedal digital tufts undergo a variety of pathological alterations useful in the recognition of disorders traditionally considered neuropathic in aetiology and in distinguishing differential considerations. Tuft flattening appears specific for alcoholism and neurosyphilis, and misaligned fractures seem specific for neurosyphilis and leprosy, providing differential assistance related to spondyloarthropathy. Conversely, periosteal reaction distinguishes spondyloarthropathy from leprosy.
Identifier
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<a href="http://doi.org/10.1136/ard.2004.021303" target="_blank" rel="noreferrer noopener">10.1136/ard.2004.021303</a>
Rights
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Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
*Foot Bones/pathology
2005
Adult
Alcoholism/complications
Annals of the rheumatic diseases
Arthropathy
Behnam S
Bone/etiology
Diabetes Mellitus/pathology
Diagnosis
Diaphyses/pathology
Differential
Female
Fractures
Humans
Leprosy/diagnosis/pathology
Male
Middle Aged
Neurogenic/*diagnosis/etiology/pathology
Neurosyphilis/diagnosis/pathology
Rothschild B M
Scleroderma
Spondylarthropathies/*diagnosis/pathology
Stroke/complications
Systemic/diagnosis