 Thirdly, this patient does have chronic distal ischemic problems with evidence of "ping-pong ball sign" due to fat atrophy at the finger tips and some periodic cracking and ulceration at the tips of the fingers. 
Thirdly , this patient does have chronic distal ischemic problems with evidence of " ping - pong ball sign " due to fat atrophy at the finger tips and some periodic cracking and ulceration at the tips of the fingers .