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nail

 [nāl]
1. a rod of metal, bone, or other material used for fixation of the ends of fractured bones.
2. a hardened or horny cutaneous plate overlying the dorsal surface of the distal end of a finger or toe. The nails are part of the outer layer of the skin and are composed of hard tissue formed of keratin. Called also unguis.
Parts of the nail. From Dorland's, 2000.
Nail abnormalities. From Lammon et al., 1996.
ingrown nail see ingrown nail.
spoon nail a nail with a concave surface.

nail

(nāl),
1. One of the thin, horny, translucent plates covering the dorsal surface of the distal end of each terminal phalanx of fingers and toes. A nail consists of corpus or body, the visible part, and radix or root at the proximal end concealed under a fold of skin. The underpart of the nail is formed from the stratum germinativum of the epidermis, the free surface from the stratum lucidum, and the thin cuticular fold overlapping the lunula representing the stratum corneum. Synonym(s): unguis [TA], nail plate, onyx
2. A rod of metal or other solid substance, used in operations to fasten together the fragments of a broken bone.
[A.S. naegel]

nail

(nāl)
1. the horny cutaneous plate on the dorsal surface of the distal end of a finger or toe.
2. a rod of metal, bone, or other material for fixation of fragments of fractured bones.

ingrown nail  aberrant growth of a toenail, with one or both lateral margins pushing deeply into adjacent soft tissue.
racket nail  a short broad thumbnail.
spoon nail  one with a concave surface.

nail

(nāl)
n.
1. A slender rod used in operations to fasten together the divided extremities of a broken bone.
2. A fingernail or toenail.
3. A claw or talon.

nail

Etymology: AS, naegel
1 also called unguis. A flattened elastic structure with a horny texture at the end of a finger or a toe. Each nail is composed of a root, body, and free edge at the distal extremity. The root fastens the nail to the finger or the toe by fitting into a groove in the skin and is closely molded to the surface of the dermis. The nail matrix beneath the body and the root projects longitudinal vascular ridges, which are easily visible through the translucent tissue of the body. The matrix firmly attaches the body of the nail to the underlying connective tissue. The whitish lunula near the root contains irregularly arranged papillae that are less firmly attached to the connective tissue than the rest of the matrix. The cuticle is attached to the surface of the nail just ahead of the root.
2 any of various metallic nails used in orthopedics to fasten together bones or pieces of bone.
enlarge picture
Nail

nail

Orthopedics A cylindrical metal device constructed of stainless steel used to hold 2 or more pieces of fractured bone in place

nail

(nāl)
1. One of the thin, horny, translucent plates covering the dorsal surface of the distal end of each terminal phalanx of fingers and toes. A nail consists of a visible corpus or body, and a radix or root at the proximal end concealed under a fold of skin. The under part of the nail is formed from the stratum germinativum of the epidermis, and the free surface from the stratum lucidum, with the thin cuticular fold that overlaps the lunula representing the stratum corneum.
2. A slender rod of metal, bone, or other solid substance, used in operations to fasten together the divided extremities of a broken bone.
Synonym(s): unguis [TA] , nail plate, onyx.

nail

(nal)
1. A rod made of metal, bone, or other solid material used to attach the ends or pieces of broken bones.
Enlarge picture
FINGERNAIL
2. A horny cell structure of the epidermis forming flat plates upon the dorsal surface of the fingers and toes. Synonym: onyx; unguis See: illustration

A fingernail or toenail consists of a body composed of keratin (the exposed portion) and a root (the proximal portion hidden by the nail fold), both of which rest on the nailbed (matrix). The latter consists of epithelium and corium continuous with the epidermis and dermis of the skin of the nail fold. The crescent white area near the root is called the lunula. The epidermis extending from the margin of the nail fold over the root is called eponychium; that underlying the free border of the distal portion is called hyponychium.

A nail grows in length and thickness through cell division in the stratum germinativum of the root. The average rate of growth in fingernails is about 1 mm per week. Growth is slower in toenails and slower in summer than in winter. Nail growth varies with age and is affected by disease and certain hormone deficiencies. The onset of a disease that briefly interferes with nail growth and development may be estimated by measuring the distance of the line (Beau line) across the nail from the root of the nail.

Differential Diagnosis

Changes in the nails, such as ridges, may occur after a serious illness or indicate defective nutrition. In achlorhydria and hypochromic anemia, excessively spoon-shaped nails that are depressed in the center may occur. In chronic pulmonary conditions and congenital heart disease, a spongy excess of soft tissue at the base of the nails may be associated with clubbed fingers. See: clubbing

Atrophy may occur as a result of hereditary or congenital tendencies. Permanent atrophy may follow injuries, scars from disease, frostbite, nerve injuries, and hyperthyroidism. Nail shedding is due to the same causes. Fragile or split nails often occur as a congenital condition or may be due to prolonged contact with chemicals or too frequent buffing or filing of the flat surface of the nail during manicuring. In a healthy person brittle nails are usually caused by exposure to solvents, detergents, and soaps. The brittleness disappears when the external causes are avoided. Dry, malformed nails may be due to trophic changes resulting from injury to a nerve or a finger or from neuritis, Raynaud disease, pulmonary osteoarthropathy, syphilis, onychia, scleroderma, acrodermatitis, or granuloma fungoides of the fingers. Transverse lines (Beau lines) may result from previous interference of nail matrix growth. These lines may be caused by local or systemic conditions. The approximate date of the lesion may be determined because it takes 4 to 6 months for the fingernail to be replaced. Chancre may be suspected if a small indolent ulcer appears near the nail, esp. if indurated and associated with enlarged lymph glands above the inner condyle. Quincke capillary pulsation, indicated by a rhythmic flushing and blanching under the nails, is seen most frequently in aortic regurgitation and often in anemia.

Discoloration of nails is seen in various medical conditions. Black discoloration may be seen in diabetic and other forms of gangrene. Blue-black discoloration is a common condition due to hemorrhage caused by bleeding diseases, such as hemophilia, or trauma. This condition may be painful and can be relieved by drilling a small hole in the nail at the site of the hemorrhage. A dental drill, the heated tip of a paper clip, or a similar rigid wire of small diameter may be used. Brown discoloration may be due to arsenic poisoning. Brownish-black discoloration often indicates chronic mercury poisoning due to the formation of sulfide of mercury in the tissues. Cyanosis of the nails usually indicates anemia, poor circulation, or venous stasis. Green staining of the nail fold or under the nail is associated with the growth of Pseudomonas in a wet area. Slate discoloration is an early manifestation of argyria, and intake of silver should be stopped at once. White spots or striate lesions may be due to trauma and are more frequently seen in women. Transverse white bands in all nails may be a sign of acute or chronic arsenic poisoning or, rarely, of thallium acetate poisoning. See: Mees lines

eggshell nail

A condition in which the nail plate is soft and semitransparent, bends easily, and splits at the end. The condition is associated with arthritis, peripheral neuritis, leprosy, and hemiplegia. It may be the only visible sign of late syphilis.

fungal infection of nail

See: infection

habit deformity nail

Disruption of the nail surface by the habit of abrading or stroking that area. This produces a wavy or washboard-like nail surface.

hang nail

Broken epidermis at the edge of a nail.

ingrown nail

Growth of the nail edge into the soft tissue, causing inflammation and sometimes an abscess. Ingrown nails may be due to improper paring of the nails or pressure on a nail edge from improperly fitted shoes. In many cases, this condition may be prevented by cutting the nails straight across.

intramedullary nail

A surgical rod inserted into the intramedullary canal to act as an immobilization device to hold the two ends of a fractured long bone in position.

reedy nail

A nail marked by longitudinal fissures.

Smith-Petersen nail

See: Smith-Petersen nail

splitting nail

A troublesome condition in which the brittle nails split easily. Polishing, buffing, or abrading the nail surface will weaken the nail; thus, these practices should be discouraged. Brittle nails should be soaked, preferably in bath oil, prior to cutting them.

spoon nail

A nail with a depressed center and elevated lateral edges. This condition may follow trauma to the nail fold or iron deficiency anemia or may develop naturally.
See: koilonychia for illus.

nail

1. A protective and functional plate of a hard, tough protein, KERATIN, lying on the back surface of the last PHALANX of each finger and toe.
2. A steel rod used surgically to secure bone fragments in apposition.

nail

a horny, keratinized layer protecting the distal end of each finger and toe in humans and most other primates. In other terrestrial vertebrates the nail is shaped into a claw or amalgamated into a hoof.

nail

steel rod; used to approximate and fixate fractured bone ends

nail

the continuously growing, flexible, keratin plate at the dorsal aspect of the tip of a digit; Figure 1; see onych-; subungual
  • black nails dark or brown-black discoloration of the nail plate/s; caused by chronic Pseudomonas infection (e.g. chronic paronychia), chronic subungual haemorrhage (e.g. due to repeated local trauma), psoralens and long-wave ultraviolet A light (PUVA) therapy, systemic chemotherapy or radiotherapy; longitudinal pigmented bands are common in black races but rare in Caucasians; dark or irregular longitudinal bands in Caucasians should undergo biopsy (to exclude malignancy)

  • blue nails; azure lunulae see argyria

  • brittle nails common condition, e.g. in middle-aged women, characterized by lamellar splits, associated with repeated immersion in detergent water

  • dystrophic nails imperfect, and/or interrupted nail plate growth or formation, e.g. Beau's lines

  • fungal nail see onychomycosis; Table 1

  • half-and-half nails white coloration of proximal half of nail plate and pink-brown coloration of distal half; associated with uraemia, chemotherapy, human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), old age

  • Hippocratic nail see clubbing of the digits

  • ingrowing nail; onychocryptosis penetration of nail sulcus by nail spicule or outer margin of nail plate, with associated local tenderness, swelling, pain, inflammation, infection (paronychia) and granuloma (hypergranulation) formation; most commonly affects hallux nail, often in adolescent males (see Table 2)

  • involuted nail; pincer nail; omega nail exaggerated transverse curvature of nail plate; outer borders are deeply embedded within and obscured by surrounding soft tissues; prone to onychocryptosis and onychophosis

  • lamellar splits separation of nail plate into dorsal and intermediate layers

  • nail avulsion see traumatic avulsion; Table 3

  • nail bed soft tissue at dorsal tip of digit, underlying and visible through nail plate

  • nail haemorrhage see splinter haemorrhage; subungual haematoma

  • nail thickening hypertrophy and overgrowth of nail plate, with or without distortion; indicative of previous nail trauma (i.e. one severe blow, or repeated/chronic minor trauma), fungal infection or skin disease (e.g. psoriasis, pachyderma congenita); see onychauxis; onychogryphosis; onychomycosis

  • nails in alopecia areata linear pattern of very fine pits of nail plate and stippling/redness of lunulae, due to autoimmune changes in patients with, or who will develop, alopecia areata

  • nails in chemotherapy nail dystrophy, hyperpigmentation and infection due to systemic effects of chemotherapy, e.g. transverse white bands (each band representing one chemotherapy cycle), Beau's line formation, nail loss (due to drug effect on nail keratinocytes), diffuse or banded (transverse or longitudinal) hyperpigmentation (due to nail bed melanocyte overactivity), subungual haemorrhages (due to overreaction to local trauma) and acute paronychia and/onychomycosis (due to drug-related immunosuppression)

  • nails in Darier's disease small 'notch' at free margin of affected nail + local subungual hyperkeratosis, linked to single/multiple longitudinal red streaks in nail, extending from free margin to eponychium

  • nails in dermatomyositis e.g. pterygium inversus unguis formation, eponychial 'fraying', inflammation and swelling of proximal nail folds, local telangiectasia, and dilated and tortuous capillaries of dorsal nail fold; reflecting earlier active periods of dermatomyositis

  • nails in lichen planus e.g. plate thinning, irregularity and longitudinal ridging, onycholysis, pterygium formation, twenty-nail dystrophy and/or anonychia (due to scarring of the nail matrix); noted in 10% of patients with lichen planus

  • nails in pityriasis rubra pilaris thickening and onycholysis with severe subungual hyperkeratosis and nail splinters

  • nails in psoriasis generalised dystrophy due to effects of psoriatic lesions within elements of nail apparatus (i.e.: nail bed, matrix plate), e.g.: onychauxis, central, distal or total onycholysis, chromonychia, paronychia, pronounced nail plate ridging (trachyonychia); thimble pitting, oil spot sign and pustular atrophy of nail bed (acrodermatitis continua of Hallopeau)

  • nails in Reiter's disease psoriatic-like changes, with nail tenderness, marked pitting, subungual pustule formation and periungual psoriasis-like lesions

  • nails in scleroderma e.g. micro-nychia, thin and flattened nail plates, marked (longitudinal/transverse) distal nail plate overcurvature, pterygium inversus unguis, and increased distal overgrowth of eponychium

  • nails in systemic lupus erythematosus and mixed connective tissue disease e.g. onycholysis, red lunulae, pterygium inversus unguis, severe nail dystrophy with deep longitudinal nail furrows (secondary to matrix scarring) and similar nail effects in dermatomyositis

  • nails in tuberose sclerosis isolated or multiple garlic clove fibromas (Koenen's tumours) growing out from proximal nail folds; overlie/distort the local nail plate

  • omega nail see nail, involuted

  • ostler's nail; ram's horn nail gross nail plate thickening (onychauxis), distortion (onychogryphosis) and overcurvature; caused by trauma-related scarring of nail matrix, e.g. subsequent to dropping a heavy object on the toe and matrix area

  • parrot beak nail distally tapering, thickened nail plate, overcurved in its longitudinal axis

  • pincer nail; trumpet nail increased transverse overcurvature of distal one-third of nail plate; lateral nail edges converge distally and traumatize/perforate medial and lateral nail folds; distal one-third of nail may form a cylinder and strangulate entrapped nail bed soft tissues in extreme cases

  • plicatured nail; tile nail lateral nail involution, i.e. normal central transverse curvature of main plate, but exaggerated curvature at lateral margins; nail plate edges are deeply embedded within nail sulci

  • ram's horn nail see nail, ostler's

  • red nails; red lunulae red-purple discoloration of proximal nail and hyperaemia of local nail bed; associated with e.g. systemic lupus erythematosus, alopecia areata and some drug therapies

  • reed nail see onychorrhexis

  • retinoid nails e.g. thinning and brittleness of entire nail plate, transverse ridging and white banding, Beau's lines, onychomadesis, acute paronychia; secondary to systemic retinoids (i.e. synthetic vitamin A analogues)

  • scroll nail inward curvature of outer border/s of nail plate (toward midline of toe) with entrapment of local soft tissues; an exaggerated form of involuted nail

  • spoon nail; koilonychia lateral/medial nail border elevation and central depression (concavity) of nail plate; associated with iron-deficiency anaemia, malnutrition, thyrotoxicosis, Raynaud's and scleroderma; note: may be normal in toddlers

  • subungual haematoma see subungual haematoma

  • terry nails thin, brittle, lustreless nails with marked longitudinal ridging/beading, narrow, transverse, red-brown band (just proximal to free margin); characteristic of old age

  • tile nail see nail, plicatured

  • trachyonychia see onychia

  • trumpet nail see nail, pincer

  • twenty-nail dystrophy see onychia

  • white nails see leukonychia; Muerke's lines

  • yellow nails yellowing of nail plate; with increased mediolateral/proximodistal curvature and loss of eponychial tissue; secondary to virtual cessation of linear nail growth but marked smooth thickening of nail plate; of obscure cause, but associated with underlying disease states, e.g. pulmonary tuberculosis

Figure 1: Nail and nail apparatus. This article was published in Neale's Disorders of the Foot, Lorimer, French, O'Donnell, Burrow, Wall, Copyright Elsevier, (2006).
Table 1: Characteristics of fungal infections in the foot
PresentationCharacteristics
Interdigital skin infection (intertrigo)Macerated tissue and webspace fissures Or dry, flaking tissue and webspace fissures ± pruritus
Moccasin skin infectionDry, flaking skin affecting most of plantar surface, border skin and extending on to the dorsum from the interdigital spaces, ± pruritus
Hyperkeratotic skin infectionIncreased formation of plantar keratin, with fissuring (especially around heels)
Vesicular skin infectionIntensely itchy, vesicular eruptions along plantar web line and medial longitudinal arch
Superficial nail infectionFormation of white, powdery patches or plaques on dorsal surface of one or many nails (also known as white superficial onychomycosis)
Tobacco nailFormation of white/yellow/brown streak extending from distal to proximal area of intermediate nail plate, with local plate dystrophy
Total onychomycosisContamination of the entire nail plate by fungal infection, leading to plate hypertrophy, dystrophy, discoloration and onycholysis
Table 2: Presentations and treatment approaches for ingrown toenail
StageCharacteristics
IPatient complains of pain in the nail sulcus, especially in shoes
Minimal visual signs of IGTN (slight swelling, slight redness)
• May resolve with local removal of nail spike or small sliver of the outer margin of the nail plate and gentle packing of the sulcus with sterile cotton wool
IIPatient complains of acute pain
Visual signs of local inflammation: redness, swelling; hyperhidrosis
Hypergranulation arising from affected nail sulcus
Seropurulent (smelly) discharge
• May resolve with local removal of nail spike or small sliver of nail plate under local anaesthetic, together with gentle packing of the sulcus with sterile cotton wool
• May require excision of the section of the nail plate, together with gentle packing of the sulcus with sterile cotton wool, but there is a high risk that the problem will recur as the nail plate regrows
• May require excision of the section of the nail plate, together with ablation of the exposed pocket of matrix (by application of phenol or potassium hydroxide or electrosurgery or surgical excision); the hypergranulation tissue may be excised, or left in situ where it will gradually atrophy over the next 2 weeks; there is an approximately 5% risk of regrowth of the excised section of nail plate
IIILong-standing IGTN
As stage II, but epidermal overgrowth of granulation tissue
Table 3: Presentations and treatment approaches for ingrown toenail
StageCharacteristics
IPatient complains of pain in the nail sulcus, especially in shoes
Minimal visual signs of IGTN (slight swelling, slight redness)
• May resolve with local removal of nail spike or small sliver of the outer margin of the nail plate and gentle packing of the sulcus with sterile cotton wool
IIPatient complains of acute pain
Visual signs of local inflammation: redness, swelling; hyperhidrosis
Hypergranulation arising from affected nail sulcus
Seropurulent (smelly) discharge
• May resolve with local removal of nail spike or small sliver of nail plate under local anaesthetic, together with gentle packing of the sulcus with sterile cotton wool
• May require excision of the section of the nail plate, together with gentle packing of the sulcus with sterile cotton wool, but there is a high risk that the problem will recur as the nail plate regrows
• May require excision of the section of the nail plate, together with ablation of the exposed pocket of matrix (by application of phenol or potassium hydroxide or electrosurgery or surgical excision); the hypergranulation tissue may be excised, or left in situ where it will gradually atrophy over the next 2 weeks; there is an approximately 5% risk of regrowth of the excised section of nail plate
IIILong-standing IGTN
As stage II, but epidermal overgrowth of granulation tissue

nail

(nāl)
1. One of the thin, horny, translucent plates covering dorsal surface of distal end of each terminal phalanx of fingers and toes.
2. Generally, a metal rod, used in operations to attach fragments of a broken bone.

nail

1. a rod of metal, bone or other material used for fixation of the ends of fractured bones.
2. see horseshoe nail (below).
3. a horny cutaneous plate overlying the dorsal surface of the distal phalanx of the human fingers and toes; similar structures are found in other primates.
4. (loosely) one of the claws of dogs, cats, chickens, etc.

nail bed infection
nail bind
usually used to indicate a nail prick of the horse's hoof caused by the blacksmith driving a nail too close to the soft tissues and causing pressure on the sensitive laminae without penetrating them. See also nail prick (below).
nail-hole curette
a curette with a fine stem and a tiny, half-cup shaped end designed to be inserted in a nail-hole in the hoof to curette out damaged tissue and to provide drainage. Called also Hughes nail-hole curette.
nail dermatophytosis
horseshoe nail
a nail made of a special soft metal and with a specific shape that directs the point of the nail away from the soft tissues and out through the side wall of the hoof.
interlocking nail
an intramedullary nail secured by transverse screws through the proximal and distal fragments.
intramedullary nail
one placed within the medullary cavity, bridging the fracture site and providing support and immobilization although rotation may be a problem. See internal fixation.
nail prick
penetration of the sole of the horse's hoof by a nail or other sharp object to the depth of the sensitive laminae. Causes acute lameness and may lead to infection, hoof abscess and tetanus. See also nail bind (above). Called also nail tread.
pulled nail
an injury common in racing Greyhounds, in which the attachment of the nail to the nail bed is separated by trauma. Causes severe pain and lameness.
nail tread
see nail prick.
nail trimmers

Patient discussion about nail

Q. My nails are black- is it dangerous? Hi, I was diagnosed with colon cancer and now I receive chemotherapy. This morning I found that my nails are brown and blue, and other nails have white lines on them. Is that dangerous? Should go and see a doctor?

A. The chemo can cause several changes in your nail, e.g. make them brittle etc. You can find some more info at : http://www.breastcancer.org/tips/hair_skin_nails/nails.jsp

Q. my guy friend has a very sick looking toe nail, what should he do? its really thick and has ridges, its also dark yellow and it looks to me has thick toe jam too... ugh, he needs your help please!

A. It sounds like Toenail fungus. Symptoms of toenail fungus, which can be caused by several types of fungi, include swelling, yellowing, thickening or crumbling of the nail, streaks or spots down the side of the nail, and even complete loss of the nail. Toenail color can vary from brown or yellow to white with this condition. I suggest your friend goes to see a foot doctor. The doctor might remove as much of the nail as possible by trimming, filing or dissolving it. Medicated nail polish might be prescribed for a localized infection, but a serious infection will likely be treated with a prescription oral antifungal medication. Only in severe cases will surgical removal of the nail be recommended.

Q. what natural cure for toe nail fungus really works?

A. Haven't heard about anything natural that was actually provent in reliable, well controlled trial. Especially since natural medications usually aren't tested in this way, I'm not sure there can be an accurate and true answer for this question.

More discussions about nail