Public concern over the condition of King Charles’s swollen hands and fingers is not new. They drew attention at the funeral of his father, Prince Philip, in April last year and as far back as 1982 the then Prince wrote to a friend that the newborn Prince William had similarly sausage-like fingers.
One of the possibilities suggested in the media is that the 73-year-old King has oedema, or fluid retention, a common and usually harmless condition that mostly affects over-65s as the ability for fluid control is restricted. Oedema is commonly caused by standing or sitting for too long and can be down to a hereditary predisposition.
While Maxim Horwitz, a consultant orthopaedic hand and wrist surgeon in the hand unit at Chelsea and Westminster Hospital, can’t comment on what the appearance of the King’s hands might mean without having examined him and knowing his health history, he says our hands have long been a gateway for medics to determine the wider health of an individual.
“In classic medical training, students are always taught to look at hands, which probably doesn't happen as much anymore because we can do scans and blood tests. But the hands can confirm various systemic diseases,” says Horwitz who founded The Hand Doctor Practice, which offers a private-patient hand surgery service.
So what are the red flags to look out for?
Red streaks on fingernails
Our nails in particular can carry warning signs of liver disease, cancer, lung disease, tuberculosis and vitamin deficiencies. “If you’ve got an infection on your heart valves you get what are called splinter bleeds, little red streaks in your nails,” says Horwitz. “The theory is that tiny little blood clots come out from the valves in the heart where the blood is not flowing nicely because of infective vegetations [lesions] on the heart and these tiny clots come to the fingernails and these are what caused the splinter haemorrhages.”
Black spot on the nail
“While white spots probably aren’t anything to worry about, an isolated black spot is something that needs investigating,” says Horwitz. “Melanoma you can see on the nail. People walk around with a black nail and think they’ve bruised it, but they may have a melanoma hiding in their nails.”
White patches can be a sign of heart disease, kidney failure, liver cirrhosis or diabetes amongst other conditions, but this is not commonly the case – they’re more likely to be down to deficiency. However, those youthful “calcium spots” are not, in fact, a sign you’re lacking calcium. “They are not calcium spots but rather signs of minor trauma, or deficiencies such as zinc or other more serious conditions,” says Horwitz.
Clubbing nails, which take on a curved appearance with swollen, bulbous fingertips, can be indicative of severe lung disease or cancer in your lungs and are the result of chronically low blood levels of oxygen. However, adds Horwitz: “Some people are born with curved nails and have had it all their lives [in which case it can be a harmless trait].”
Pale or yellow hands
The colour of one’s hands can also be suggestive of certain conditions. Pale hands, think anaemia. Yellow, think jaundice. Meanwhile Raynaud’s syndrome, which causes spasms in small blood vessels in your fingers and toes that limit blood flow, presents as a sequence of colours: white, a little bit of blue and then red. It’s a common condition but doesn’t usually cause severe problems, unless it’s a sign of something more serious, such as rheumatoid arthritis or lupus. “A lot of us are sensitive to the cold and our fingers will change colour in the weather. True, Raynaud’s is not common but it’s not rare either. Heated gloves are very useful if you have true Raynaud’s,” says Horwitz.
Stiff or swollen hands or fingers
Stiffness can be caused by diabetes while swelling might be gout.
Many rheumatological conditions such as lupus, rheumatoid arthritis and scleroderma – all caused by the immune system attacking the body – manifest in the hands. “Tell-tale signs are varying degrees of swelling and stiffness, bending of the joints and pain in the joints and loss of power.”
Rheumatoid arthritis, not to be confused with osteoarthritis, is an inflammatory condition that affects the whole body. “It’s a minority of people who have inflammation in their joints that then damages the joints.”
Lumps and bumps
Cysts and lumps and bumps in the palm might be symptomatic of Dupuytren’s Contracture, which runs in families, but is also linked to tobacco and alcohol use. The condition suffered by Margaret Thatcher causes the little finger to withdraw into the palm, which, if untreated, can cause loss of use of the hand. “It’s extremely common and can be on a spectrum from very mild to very severe,” says Horwitz. “The actor Bill Nighy has it, but has never had surgery.”
In Howitz’s practice, he aims to diagnose and treat the condition as early as possible.
Not all lumps and stiffness are a sign of something more sinister. “Almost everyone has got arthritis at the bottom of their thumbs by the end of their life,” says Horwitz. “Arthritis means wear and tear of the cartilage but not everyone feels it. The joint degenerates because the cartilage doesn’t live forever.”
Heberden’s nodes, the lumpy bumpy bits at the tips of the fingers, are typical of the condition and not to be worried about. “Osteoarthritis is a perfectly normal result of wear and tear,” he says.
Nine times out of 10 tremors are nothing to worry about, says Horwitz: “Some people just have shaky hands. However one in 10 times might actually be Parkinson’s.”
Hand flapping is also a symptom of chronic liver disease; the loss of muscle control is also accompanied by irregular and involuntary jerking movements caused by toxins building up in the blood resulting in brain damage.
Other symptoms that might alert you to wider health problems include nerve compression, which might have its origin in the arms and the neck, but manifest in the hand.
...and here’s how to keep your hands healthy
Some deterioration of the hands and fingers is a certainty of old age, but that doesn’t mean there aren’t things we can do to take care of our hands.
“From a general point of view, don't smoke,” says Horwitz: “That’s probably the key message. Smoking 100 per cent shrinks your blood vessels and makes it much more difficult for the blood to get down to where it should be. It's the absolute enemy.”
Gloves are also advisable when you're doing gardening or DIY. “If you're going to the gym and doing exercises with a trainer, make sure you wrap and tape up appropriately so you don’t injure your wrists.”
Nutritionally, Horwitz says there’s moderate evidence that dietary supplements can help your joints. “Things like glucosamine and fish oils. And there’s early evidence that oestrogen is protective for the perimenopausal, where there is known to be a slight increase in arthritis.”
Taking care of your hands can start at any age though: “You can manage things by good general health, not smoking and protecting your hands.”