3718 : WHEN YOUR FINGERS BECOME TO BROAD TO PLAY THE GUITAR

Author(s): 
Moeremans, Paul; Morren, Marie-Anne
Text: 
Poster
A 15 year old boy came to our consultation with the complaint that his fingers became so swollen that playing the guitar became difficult. The boy was in good health. There were no complaints of morning stiffness. The swelling of his fingers started two years earlier at the lateral parts of the PIP joints of fingers Ill of both hands. Progressively fingers II and IV and finally the radial aspect of finger V and of the ulnar aspect of his thumbs became involved and the swelling extended to the proximal parts of the fingers. The clinical picture showed thickening of the skin and underlying tissues. There was some scaling and erythema. Palpation of the lesions was not painful. A skin biopsy showed an epiderm that was slightly thickened and parakeratotic, the underlying dermis was broadened, collagen fibres were augmented, whereas elastic fibres were sparse. X-ray of the hands showed no bone deformities, only a soft tissue swelling. Rheumatologic blood tests were negative. The diagnosis pachydermodactyly was made, this is a rare skin condition, particularly affecting teenage boys. The boy had the strange habit of interlacing and squeezing his fingers when he had found the solution of a computer game. After stopping this habit the lesions slowly regressed. This case illustrates that a good clinical examination and thorough history taking can prevent extensive investigations and heroic treatments when the correct diagnosis is made.
Topic: Clinical Practice