This post is a result of a Tweet that reminded me of my clinical medicine lectures from a several years ago when we were taught that as medical practitioners, we would sometimes be required to act as detectives. Here is the Tweet:

http://twitter.com/therealamerican/status/119491884321222657

A great summary of the issue is provided on the MSS website. Here is a video that explains the fundamental principle of how to shake the hands of your overly eager sexual partner-to-be in order to check them for signs of secondary syphilis:

Quoting from the MSS website:

The story goes that when sailors arrived in a new port, they would greet the girls in this manner to determine if they had syphilis. Another story goes that they did this whilst dancing. Whatever the case, it is true that the nodes swell when suffering from syphilis, although it’s not fail safe as there are a number of things that could cause the swelling, including infection.

This is indeed a very interesting point for people like me who have always been fascinated by clinical signs and the science of diagnosis by signs.Let me digress a while while I ruminate about this talk I heard by this prominent Intensivist who had this “rounds game” which was absolutely fascinating. In his talk, he said that he would start his rounds on a new patient in the ICU from an absolutely clear slate. He would walk in, do a survey of the patient, look for signs, and even before he touched the patient, he tried to sort out a list of abnormalities. He cited numerous examples where such a vigilant inspection allowed him to not fall prey to the “observer bias” where by on detecting one pathology that explains the condition of the patient, the clinician is satisfied and stops looking, thereby missing out on several other coexisting morbidities.

Anyways. Coming back to the issue of the epitrochlear nodes. Here is an excerpt from a text book for primary care physicians which quite clearly spells out the issues with the sign:

However, although it seems to be a low yield system with a lot of other potential confounding conditions that can lead to a vast number of false positives, for sign-tists like me, this is a fascinating way to scare the hell out of unsuspecting people with weird obscure trivia! Now if only I could find some proper literature on this topic… just in case you know of any please shoot me a line to pranab AT pranab DOT in.

And remember, the next time you are worried about the status of your unknown partner, just grab their hands, and give it a swing!