CLINICIANS constantly make diagnoses based on physical signs. As Sherlock Holmes well knew, open eyes connected to a receptive mind often permit a bypass of the laboratory. The sign to be described in this communication, while undoubtedly known to detectives and diagnosticians alike, seems to have been lost in the proliferating medical literature, and its rediscovery prompts this report.
Report of a Case
An elderly man was seen in consultation because of osteoarthritis of his knees and one hip. While examining him, I observed raised lesions on the upper third of both shins (Fig 1). The skin appeared thickened, but the hardness of the lesions suggested that the underlying bone was also raised. Pigmentation was similar to that of the surrounding skin, and neither heat nor local tenderness was demonstrable. Before I could fully appreciate its significance, the patient commented, "That's of no importance. Everybody I work with has it."