Fingers drumsticks in good health. Drumsticks

Hippocrates also described fingers that looked like drumsticks when studying empyema. For this reason, this pathology of the fingers and nails is named after the fingers of Hippocrates. The German doctor Eugene Bamberger and the French doctor Pierre Marie described hypertrophic osteoarthropathy back in the 19th century and pointed to the presence of fingers with glass-like nails in the disease. And already in 1918, doctors began to recognize this symptom as a sign of a chronic infection.

Fingers, similar to drum sticks, mostly form on both limbs, but in some cases, the pathology can only affect the hands or feet separately. Such an election is typical for heart disease in the cyanotic form, which developed in the womb, when blood with oxygen enters only one part of the body.

Fingers that look like drumsticks differ in what they look like:

• beak of a parrot;
• watch glasses;
• real drumsticks.

triggers

This pathology develops in the presence of the following diseases:

• lung diseases of various origins;
• endocarditis;
• congenital defects;
• ailments of the gastrointestinal tract;
• cystic fibrosis;
• Graves' disease;
• trichuriasis;
• Marie-Bamberger syndrome.

The reasons why a lesion develops on only one side can be:

• Pancoast tumor (formed when cancer first segment of the lung)
• ailments of the vessels through which the lymph flows;
• use of a fistula during hemodialysis;
• taking drugs of the angiotensin II blocker group.

The reasons

The reasons for the development of the syndrome, in which the fingers become like drum sticks, have not been identified to this day. It is only known that this pathology develops in the presence of circulatory problems. In this case, there is a violation of tissue oxygen supply.

Constant oxygen starvation provokes an expansion of the lumen of the vessels located in the phalanges of the fingers, which provokes an increase in blood flow to this area.

result this process there is a significant proliferation of connective tissue, which is located between the nail and the bone. It should be noted that there is a relationship between the level of hypoxia and external changes in the shape of the nail bed.

Studies have shown that in the presence of a chronic inflammatory disease in the intestine, oxygen starvation is not observed, but a change in the shape of the fingers and the appearance of a specific nail plate in the form of a watch glass not only develops with Crohn's disease, but may also be the first sign of this disease.

Symptoms

The manifestation, in which the nails take on the appearance of watch glasses, basically does not provoke the appearance of pain. For this reason, the patient cannot notice this change in time.

The main signs of the symptom:

If a patient has bronchiectasis, cystic fibrosis, lung abscess, chronic empyema, osteoarthropathy of the hypertrophic type, which is characterized by:

• bone pain
• changes in the characteristics of the skin in the pretibial region;
• elbows, wrists and knees have changes very similar to arthritis;
• the skin in some areas begins to coarsen;
• develops paresthesia, excessive sweating.

Diagnostics

Most often, a symptom that manifests itself with nails in the form of watch glasses signals the presence of Marie-Bamberger syndrome. If this diagnosis is not confirmed, then the doctor relies on compliance with the following criteria:

1. The Lovibond angle is measured. To do this, a pencil is applied along the finger to the nail. If there is no gap between the nail and the pencil, then it can be said without a doubt that the patient has a symptom of drumsticks. Also, a decrease in the angle or its complete disappearance is determined by studying the symptom of Shamroth.
2. Feeling the finger to determine elasticity. To do this, press on the top of the finger and immediately release. If the nail is immersed in the tissue, and after a sharp springback, then a disease can be assumed, a symptom of which is glass nails. Elderly patients have the same effect, but it is the norm and does not indicate the presence of manifestations of drumsticks.
3. The doctor checks the ratio of the thickness of the TDF and the interphalangeal joint. For normal state this figure does not exceed 0.895. If the symptom is present, that score increases to 1 or even more. This indicator is considered the most specific for this manifestation.

If there is a suspicion of a combination of hypertrophic osteoarthropathy with a symptom of drumsticks, then the doctor decides to give the patient an x-ray or scintigraphy.

Important in diagnosing why the nail becomes "glassy" is to identify the main cause of the development of this symptom. For this you need:

• study history;
• do an ultrasound examination of the lungs, heart and liver;
• study x-ray results chest;
• the doctor prescribes a computed tomography and an electrocardiogram;
• the function of external respiration is examined;
• the patient is obliged to donate blood to determine its gas composition.

Treatment

Therapy of nails in the form of watch glasses begins with the treatment of the underlying disease. To do this, the doctor recommends that the patient take:

• antibiotics;
• medicines to boost immunity.

Also, it will not be superfluous to review the diet. It is important to consult with a nutritionist and find out the list of prohibited foods for this disease.

Forecast

The prognosis of how the nails, similar to watch glasses, will look directly depends on what caused this pathology. If everything has already been cured of the underlying disease, then the symptoms decrease, and the fingers will become normal.

DRUM FINGERS(more correctly fingers shaped like drumsticks) - fingers with bulb-shaped thickening nail phalanges similar in shape to drumsticks. The name “Hippocratic fingers” sometimes used to designate such fingers is incorrect, since Hippocrates described changes only in nails that take on a resemblance to watch glasses (see Hippocratic nail). Drum fingers are found in chronic suppurative diseases of the lungs, especially in bronchiectasis, pleural empyema, cavernous tuberculosis lung, lung cancer, congenital heart disease, subacute septic endocarditis, cirrhosis of the liver and some other diseases. Thickening of the distal phalanges occurs mainly due to soft tissues (proliferation of connective tissue elements, swelling of soft tissues, periosteum). In the future, periosteal growths of the distal phalanges, as well as other bones, may develop. Some authors believe that the drum fingers are initial stage pulmonary hypertrophic osteoarthropathy described in 1890 by P. Marie. In 1891, Bamberger (E. Bamberger) described similar bone changes in patients with diseases of the lungs and heart. These changes are sometimes referred to as Marie-Bamberger's disease (see Bamberger-Marie periostosis), but this is debatable. Development drum fingers with suppuration of the lungs, it can occur already during the third month of the disease, and initial changes distal phalanges - appear even earlier. The development of the drum fingers is an indicator of the transition of suppuration of the lungs into a chronic process. After a successful radical surgical intervention, the tympanic fingers may undergo regression (N. A. Dymovich). Usually the drum fingers are equally pronounced on both sides, on the legs - weaker than on the hands. In some cases, unilateral development of the tympanic fingers (aneurysm of the subclavian artery, etc.) is described. The origin of drum fingers is explained by the toxic effect of substances absorbed from purulent and putrefactive foci, venous congestion, reflex-trophic disorders. Rarely, drum fingers are caused by a hereditary anomaly and are not a symptom of chronic inflammatory processes in the body and congenital heart defects.

Bibliography: Diseases of the respiratory system, ed. T. Garbinskogo, trans. from Polish, Warsaw, 1967; Dymovich N. A. Value of drum fingers in the forecast of pulmonary suppurations, Klin, medical, t. 73, 1950; Bamberger E. TJber die Knochenveranderungen bei chro-nischen Lungen- und Herzkrankheiten, Z. klin. Med., Bd 18, S. 193, 1891; Flusser J., S y m ο n L. a F a J-t o v a A. PaliCkovite prsty, Cas. L6k. Ces., s. 1059, 1970; Marie P. De l'os-teoarthropathie hypertrophiante pneumique, Rev. m6d., t. 10, p. 1, 1890; Mullins G.M. a. Lenhard R.E. Digital glub-bing in Hodgkin disease, Johns Hopk. med. J., v. 128, p. 153, 1971.

P. E. Lukomsky.

Watch glass symptom (Hippocratic nail)- a characteristic deformation of the nail plates in the form of watch glasses with a flask-shaped thickening of the terminal phalanges of the fingers and toes in chronic diseases of the heart, lungs, liver. At the same time, the angle that makes up the posterior nail fold and the nail plate, when viewed from the side, exceeds 180°. The tissue between the nail and the underlying bone acquires a spongy character, due to which, when pressed on the base of the nail, there is a feeling of mobility of the nail plate. In a patient with a symptom of watch glasses, when the nails of opposite hands are compared together, the gap between them disappears (Shamroth's symptom).

This symptom, apparently, was first described by Hippocrates, which explains one of the names of the symptom of watch glasses - Hippocrates' nail.

Clinical Significance

When this symptom appears, a complete and thorough examination of the patient is necessary to determine the cause of its occurrence.

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Literature

• Strutynsky A. V., Baranov A. P., Roitberg G. E., Gaponenkov Yu. P. Fundamentals of semiotics of diseases internal organs. - M .: MEDpress-inform, 2004. - S. 66-67. - ISBN 5-98322-012-8.
• Trakhtenberg A. Kh. , Chissov V. I. Clinical onco-pulmonology. - M .: GEOTAR MEDICINE, 2000. - S. 109. - ISBN 5-9231-0017-7.
• Chernorutsky M.V. Diagnosis of internal diseases. - Fourth edition, revised and expanded. - L. : MEDGIZ, 1954. - S. 279. - 50,000 copies.

see also

An excerpt characterizing the Symptom of watch glasses

The next day, Prince Andrei went on visits to some houses where he had not yet been, including the Rostovs, with whom he renewed his acquaintance at the last ball. In addition to the laws of courtesy, according to which he needed to be with the Rostovs, Prince Andrei wanted to see at home this special, lively girl, who left him a pleasant memory.

Even in antiquity, 25 centuries ago, Hippocrates described changes in the shape of the distal phalanges of the fingers, which occurred in chronic pulmonary pathologies (abscess, tuberculosis, cancer, pleural empyema), and called them "drumsticks". Since then, this syndrome has been called by his name - the fingers of Hippocrates (PG) (digiti Hippocratici).

Hippocratic finger syndrome includes two signs: "hour glasses" (Hippocratic nails - ungues Hippocraticus) and club-shaped deformation of the terminal phalanges of the fingers like "drumsticks" (Finger clubbing).

Currently, PG is considered the main manifestation of hypertrophic osteoarthropathy (GOA, Marie-Bamberger syndrome) - multiple ossifying periostosis.

Mechanisms for the development of GHGs are currently not fully understood. However, it is known that the formation of PG occurs as a result of microcirculation disorders, accompanied by local tissue hypoxia, impaired periosteal trophism and autonomic innervation against the background of prolonged endogenous intoxication and hypoxemia. In the process of PG formation, the shape of the nail plates (“watch glasses”) first changes, then the shape of the distal phalanges of the fingers changes in a club-like or cone-shaped form. The more pronounced endogenous intoxication and hypoxemia, the coarser the terminal phalanges of the fingers and toes are modified.

There are several ways to establish a change in the distal phalanges of the fingers according to the type of "drumsticks".

It is necessary to identify the smoothing of the normal angle between the base of the nail and nail roller. The disappearance of the "window", which is formed when the distal phalanges of the fingers are compared with the back surfaces to each other, is the earliest sign of thickening of the terminal phalanges. The angle between the nails normally does not extend upwards more than half the length of the nail bed. With thickening of the distal phalanges of the fingers, the angle between the nail plates becomes wide and deep (Fig. 1).

On unchanged fingers, the distance between points A and B should exceed the distance between points C and D. With "drumsticks" the ratio is reversed: C - D becomes longer than A - B (Fig. 2).

Another important sign of PG is the value of the ACE angle. On a normal finger, this angle is less than 180°, with "drumsticks" it is more than 180° (Fig. 2).

Along with the "fingers of Hippocrates" in the paraneoplastic Marie-Bamberger syndrome, periostitis appears in the region of the terminal sections of long tubular bones (often the forearms and lower legs), as well as the bones of the hands and feet. In places of periosteal changes, pronounced ossalgia or arthralgia and local palpation soreness can be noted, with x-ray examination a double cortical layer is detected, due to the presence of a narrow dense strip separated from the compact bone substance by a light gap (symptom of "tram rails") (Fig. 3). It is believed that Marie-Bamberger syndrome is pathognomonic for lung cancer, less often it occurs with other primary intrathoracic tumors ( benign neoplasms lungs, pleural mesothelioma, teratoma, mediastinal lipoma). Occasionally, this syndrome occurs in cancer of the gastrointestinal tract, lymphoma with metastases to the lymph nodes of the mediastinum, lymphogranulomatosis. At the same time, the Marie-Bamberger syndrome also develops in non-oncological diseases - amyloidosis, chronic obstructive pulmonary disease, tuberculosis, bronchiectasis, congenital and acquired heart defects, etc. One of distinguishing features of this syndrome in non-tumor diseases is a long-term (over the course of years) development of characteristic changes in the osteoarticular apparatus, while in malignant neoplasms this process is calculated in weeks and months. After a radical surgical treatment of cancer, Marie-Bamberger syndrome may regress and completely disappear within a few months.

At present, the number of diseases in which changes in the distal phalanges of the fingers are described as “drumsticks” and nails as “watch glasses” have increased significantly (Table 1). The appearance of PG often precedes more specific symptoms. It is especially necessary to remember the "ominous" connection of this syndrome with lung cancer. Therefore, the identification of signs of GHG requires the correct interpretation and implementation of instrumental and laboratory methods examinations for the timely establishment of a reliable diagnosis.

The relationship of GHG with chronic diseases lungs, accompanied by prolonged endogenous intoxication and respiratory failure(DN) are considered obvious: their formation is especially often observed in pulmonary abscesses - 70-90% (within 1-2 months), bronchiectasis - 60-70% (within several years), pleural empyema - 40-60% (within 3–6 months or more) (“rough” fingers of Hippocrates, Fig. 4) .

With tuberculosis of the respiratory organs, PGs are formed in the case of a widespread (more than 3-4 segments) destructive process with a long or chronic course(6-12 months or more) and are characterized mainly by the symptom of "watch glasses", thickening, hyperemia and cyanosis of the nail fold ("tender" fingers of Hippocrates - 60-80%, Fig. 5).

In idiopathic fibrosing alveolitis (IFA), PG occurs in 54% of men and 40% of women. It was established that the severity of hyperemia and cyanosis of the nail fold, as well as the very presence of PG, testify in favor of poor prognosis with ELISA, reflecting, in particular, the prevalence of active damage to the alveoli (ground-glass areas found during computed tomography) and the severity of proliferation of vascular smooth muscle cells in the foci of fibrosis. PG is one of the factors that most reliably indicates a high risk of developing irreversible pulmonary fibrosis in patients with ELISA, which is also associated with a decrease in their survival.

In diffuse connective tissue diseases involving the lung parenchyma, PH always reflect the severity of DN and are an extremely unfavorable prognostic factor.

For other interstitial lung diseases, the formation of PG is less typical: their presence almost always reflects the severity of DN. J. Schulze et al. described this clinical phenomenon in a 4-year-old girl with rapidly progressive pulmonary histiocytosis X. B. Holcomb et al. revealed changes in the distal phalanges of the fingers in the form of "drumsticks" and nails in the form of "watch glasses" in 5 out of 11 examined patients with pulmonary veno-occlusive disease.

As lung lesions progress, PG appear in at least 50% of patients with exogenous allergic alveolitis. It should be emphasized that a persistent decrease in the partial pressure of oxygen in the blood and tissue hypoxia in the development of GOA in patients with chronic lung diseases should be emphasized. Thus, in children with cystic fibrosis, the values ​​of partial pressure of oxygen in arterial blood and forced expiratory volume in 1 second were the smallest in the group with the most pronounced changes distal phalanges of fingers and nails.

There are isolated reports of the appearance of PG in bone sarcoidosis (J. Yancey et al., 1972). We observed more than a thousand patients with sarcoidosis of the intrathoracic lymph nodes and lungs, including skin manifestations, and in no case did we reveal the formation of PG. Therefore, we consider the presence / absence of PG as a differential diagnostic criterion for sarcoidosis and other pathologies of the chest organs (fibrosing alveolitis, tumors, tuberculosis).

Changes in the distal phalanges of the fingers in the form of "drumsticks" and nails in the form of "watch glasses" are often recorded with occupational diseases occurring with the involvement of the pulmonary interstitium. Relatively early appearance GOA is characteristic of patients with asbestosis; this feature is indicative of a high risk of death. According to S. Markowitz et al. , during a 10-year follow-up of 2709 patients with asbestosis with the development of PH, the probability of death in them increased by at least 2 times.
GHGs were detected in 42% of the surveyed coal mine workers suffering from silicosis; in some of them, along with diffuse pneumosclerosis, foci of active alveolitis were found. Changes in the distal phalanges of the fingers in the form of "drumsticks" and nails in the form of "watch glasses" are described in match factory workers who were in contact with the rhodamine used in their manufacture.

The connection between the development of PH and hypoxemia is also confirmed by the repeatedly described possibility of the disappearance of this symptom after lung transplantation. In children with cystic fibrosis, the characteristic changes in the fingers regressed during the first 3 months. after lung transplant.

The appearance of PH in a patient with interstitial lung disease, especially with a long history of the disease and in the absence of clinical signs activity of lung lesions, requires a persistent search for a malignant tumor in lung tissue. It has been shown that in lung cancer that developed against the background of ELISA, the frequency of GOA reaches 95%, while in lesions of the pulmonary interstitium without signs of neoplastic transformation, it is detected more rarely - in 63% of patients.

Fast development changes in the distal phalanges of the fingers according to the type of "drumsticks" - one of the indications for the development of lung cancer and in the absence of precancerous diseases. In such a situation, clinical signs of hypoxia (cyanosis, shortness of breath) may be absent and this sign develops according to the laws of paraneoplastic reactions. W. Hamilton et al. demonstrated that the probability of a patient having PH increased by 3.9 times.

GOA is one of the most common paraneoplastic manifestations of lung cancer; its prevalence in this category of patients can exceed 30%. The dependence of the frequency of detection of GHGs on morphological form lung cancer: reaching 35% with a non-small cell variant, with a small cell this figure is only 5%.

The development of HOA in lung cancer is associated with hyperproduction of growth hormone and prostaglandin E2 (PGE-2) by tumor cells. The partial pressure of oxygen in the peripheral blood may remain normal. It was found that in the blood of patients lung cancer with the symptom of PH, the level of transforming growth factor β (TGF-β) and PGE-2 significantly exceeds that in patients without changes in the distal phalanges of the fingers. Thus, TGF-β and PGE-2 can be considered as relative inducers of PG formation, relatively specific for lung cancer; apparently, this mediator is not involved in the development of the discussed clinical phenomenon in other chronic pulmonary diseases with DN.

The paraneoplastic nature of the “drum stick” changes in the distal phalanges of the fingers is clearly demonstrated by the disappearance of this clinical phenomenon after successful resection of a lung tumor. In turn, the reappearance of this clinical sign in a patient in whom lung cancer treatment was successful is a likely indication of tumor recurrence.

PH can be a paraneoplastic manifestation of tumors localized outside the lung area, and may even precede the first clinical manifestations. malignant tumors. Their formation is described in a malignant tumor of the thymus, cancer of the esophagus, colon, gastrinoma, characterized by a clinically typical Zollinger-Ellison syndrome, and pulmonary artery sarcoma.

The possibility of PH formation in malignant tumors of the mammary gland, pleural mesothelioma, which was not accompanied by the development of DN, has been repeatedly demonstrated.

PG is detected in lymphoproliferative diseases and leukemias, including acute myeloblastic, in which they were noted on the arms and legs. After chemotherapy, which stopped the first attack of leukemia, the signs of GOA disappeared, but reappeared after 21 months. with tumor recurrence. In one of the observations, a regression of typical changes in the distal phalanges of the fingers was stated with successful chemotherapy and radiotherapy lymphogranulomatosis.

Thus, PG, along with various types of arthritis, erythema nodosum and migrating thrombophlebitis are among the frequent extraorganic, nonspecific manifestations of malignant tumors. The paraneoplastic origin of changes in the distal phalanges of the fingers in the form of "drum sticks" can be assumed with their rapid formation (especially in patients without DN, heart failure and in the absence of other causes of hypoxemia), as well as in combination with other possible extraorganic, nonspecific signs of a malignant tumor - an increase in ESR, changes in the picture of peripheral blood (especially thrombocytosis), persistent fever, articular syndrome and recurrent thrombosis of various localization.

One of the most common causes of PH is considered congenital heart defects, especially the "blue" type. Among 93 patients with pulmonary arteriovenous fistulas, observed in the Mauo clinic for 15 years, such changes in the fingers were registered in 19%; they outnumbered hemoptysis (14%), but were inferior to murmurs over the pulmonary artery (34%) and shortness of breath (57%).

R. Khousam et al. (2005) described an ischemic stroke of embolic origin that developed 6 weeks after delivery in an 18-year-old patient. The presence of characteristic changes in the fingers and hypoxia, which required respiratory support, led to the search for an anomaly in the structure of the heart: transthoracic and transesophageal echocardiography revealed that the inferior vena cava opened into the cavity of the left atrium.

PGs can "discover" the existence of pathological shunting from the left heart to the right, including those formed as a result of cardiac surgery. M. Essop et al. (1995) observed characteristic changes in the distal phalanges of the fingers and increasing cyanosis for 4 years after balloon dilatation of rheumatic mitral stenosis, the complication of which was a small atrial septal defect. During the period that has passed since the operation, its hemodynamic significance has increased significantly due to the fact that the patient also developed rheumatic stenosis of the tricuspid valve, after correction of which indicated symptoms have completely disappeared. J. Dominik et al. noted the appearance of PH in a 39-year-old woman 25 years after successful repair of an atrial septal defect. It turned out that during the operation, the inferior vena cava was erroneously directed to left atrium.

PG is considered one of the most typical non-specific, so-called non-cardiac, clinical signs of infective endocarditis (IE). The frequency of changes in the distal phalanges of the fingers in the form of "drumsticks" in IE can exceed 50%. In favor of IE in a patient with PH, high fever with chills, an increase in ESR, and leukocytosis testify; anemia, a transient increase in the serum activity of hepatic aminotransferases, and various variants of kidney damage are often observed. To confirm IE, transesophageal echocardiography is indicated in all cases.

According to some clinical centers, one of the most common causes of the PH phenomenon is cirrhosis of the liver with portal hypertension and progressive dilatation of the vessels of the pulmonary circulation, leading to hypoxemia (the so-called pulmonary-renal syndrome). In such patients, GOA, as a rule, is combined with cutaneous telangiectasias, often forming "fields spider veins» .
A relationship has been established between the formation of GOA in liver cirrhosis and previous alcohol abuse. In patients with cirrhosis of the liver without concomitant hypoxemia, PG, as a rule, is not detected. This clinical phenomenon is also characteristic of primary cholestatic liver lesions requiring its transplantation into childhood, including congenital atresia bile ducts.

Repeated attempts have been made to decipher the mechanisms of development of changes in the distal phalanges of the fingers according to the type of "drumsticks" in diseases, including those mentioned above ( chronic diseases lungs, congenital heart defects, IE, liver cirrhosis with portal hypertension), accompanied by persistent hypoxemia and tissue hypoxia. Leading value in the formation of changes in the distal phalanges and nails of the fingers, hypoxia-induced activation of tissue growth factors, including platelet growth factors, is imparted. In addition, patients with PH showed an increase serum level hepatocyte growth factor, and vascular factor growth. The connection between the increase in the activity of the latter and the decrease in the partial pressure of oxygen in the arterial blood is considered the most obvious. Also, in patients with PH, a significant increase in the expression of factors of type 1a and 2a induced by hypoxia is found.

In the development of changes in the distal phalanges of the fingers according to the type of "drumsticks", endothelial dysfunction associated with a decrease in the partial pressure of oxygen in the arterial blood may have a certain significance. It has been shown that in patients with GOA, the serum concentration of endothelin-1, the expression of which is induced primarily by hypoxia, significantly exceeds that in healthy people.
It is difficult to explain the mechanisms of PG formation in chronic inflammatory bowel diseases, for which hypoxemia is not typical. However, they are often found in Crohn's disease (they are not characteristic of ulcerative colitis), in which a change in the fingers like "drumsticks" may precede the actual intestinal manifestations of the disease.

Number probable causes, causing a change in the distal phalanges of the fingers according to the type of "watch glasses", continues to increase. Some of them are very rare. K. Packard et al. (2004) observed the formation of PG in a 78-year-old man who took losartan for 27 days. This clinical phenomenon persisted when losartan was replaced by valsartan, which allows us to consider it an undesirable reaction to the entire class of angiotensin II receptor blockers. After switching to captopril, the changes in the fingers completely regressed within 17 months. .

A. Harris et al. found characteristic changes in the distal phalanges of the fingers in a patient with primary antiphospholipid syndrome, while signs of thrombotic damage to the pulmonary vascular bed were not detected in him. The formation of PGs is also described in Behcet's disease, although it cannot be completely ruled out that their appearance in this disease was accidental.
PG is considered among the possible indirect markers of drug use. In some of these patients, their development may be associated with a variant of lung damage or IE that is characteristic of drug addicts. Changes in the distal phalanges of the fingers according to the type of "drumsticks" are described in users of not only intravenous, but also inhaled drugs, for example, in hashish smokers.

With an increasing frequency (at least 5%), PG is recorded in HIV-infected people. Their formation may be based on various forms of HIV-associated lung diseases, but this clinical phenomenon is observed in HIV-infected patients with intact lungs. It has been established that the presence of characteristic changes in the distal phalanges of the fingers in HIV infection is associated with a lower number of CD4-positive lymphocytes in the peripheral blood, in addition, interstitial lymphocytic pneumonia is more often recorded in such patients. In HIV-infected children, the appearance of PH is a likely indication of pulmonary tuberculosis, which is possible even in the absence of Mycobacterium tuberculosis in sputum samples.

The so-called primary form of GOA, not associated with diseases of the internal organs, is known, often having a family character (Touraine-Solanta-Gole syndrome). It is diagnosed only with the exclusion of most of the causes that can cause the appearance of PG. Patients with the primary form of GOA often complain of pain in the area of ​​altered phalanges, excessive sweating. R. Seggewiss et al. (2003) observed primary GOA involving the fingers of the lower extremities only. At the same time, when stating the presence of PG in members of the same family, it is necessary to take into account the possibility of their having inherited congenital heart defects (for example, non-closure of the ductus arteriosus). The formation of characteristic changes in the fingers can continue for about 20 years.

Recognition of the causes of changes in the distal phalanges of the fingers according to the type of "drumsticks" requires differential diagnosis of various diseases, among which the leading position is occupied by those associated with hypoxia, i.e. clinically manifested DN and / or heart failure, as well as malignant tumors and subacute IE. Interstitial lung disease, primarily ELISA, is one of the most common causes of PH; the severity of this clinical phenomenon can be used to assess the activity of the lung lesion. The rapid formation or increase in the severity of GOA necessitates the search for lung cancer and other malignant tumors. At the same time, one should take into account the possibility of this clinical phenomenon occurring in other diseases (Crohn's disease, HIV infection), in which it can occur much earlier than specific symptoms.

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People suffering chronic pathologies lungs, heart, and liver may be bulb-shaped. In medicine, this is called drumstick syndrome. The disease, as a rule, does not bring tangible pain and does not affect tissues. skeletal system. soft tissues of all fingers of both hands and feet change their thickness, changing the angle towards increase in the gap between the nail plate and the nail fold of the back wall of the nail. The nail becomes distorted, deformed.

general information

For the first time, the world learned about the existence of fingers in the form of drumsticks from Hippocrates, who mentioned them in the description of purulent accumulations in the body and genitals. Thereafter this pathology limbs became known as the fingers of Hippocrates.

Doctors Eugene Bamberger, a German by birth and Frenchman Marie Pierre, identified osteoarthropathy of hypertrophic etiology in the nineteenth century, in which a pathology developed on the phalanges of the fingers called drumsticks. It was then that doctors found that the cause of this disease is chronic pathogenic infections.

Forms of the disease

Often, fingers that resemble drumsticks appear on the legs and arms at the same time. However, there are cases when the pathology occurs in isolation, only on the legs or arms. Special cyanotic changes in the extremities appear in people with chronic heart disease, when only one half is supplied with blood human body: lower or upper respectively.

« Drumsticks There are several types on the phalanges of the limbs:

• Soft tissues grow around the entire phalanx. Real flask-shaped sticks.
• The distal phalanx maximizes in size only on one side. Visually resemble the beak of a parrot.
• The nail is deformed due to the growth of soft tissues under the plate. This type is similar to watch glasses.

Main reasons

The main causes that provoke the symptom of drum sticks:

• Pulmonary diseases, including: abscesses, oncological diseases, pleurisy, lung cyst, fibrous type alveolitis, chronic suppuration processes.
• Diseases of the cardiovascular system: heart disease of congenital etiology, endocarditis infectious origin. In such cases, the disease is accompanied by additional swelling and cyanosis of the skin on the arms and legs.
• Diseases of the gastrointestinal tract: gastric ulcers, cirrhosis of the liver, colitis, enteropathy.

There are a number of other diseases in which a symptom occurs:

This pathology of the limbs is the main type of Marie-Bamberger syndrome, which affects the tubular bones in the body, and is aggravated by a bronchogenic type of cancer. The second name is hypertrophic osteoarthropathy.

Causes that provoke the appearance of unilateral pathology of the limbs:

• The presence of an inflammatory process in the lymphatic vessels.
• Pancoast formation is a tumor that appears on the first pulmonary segment.
• The use of AV fistula during treatment kidney failure by hemodialysis.

The mechanism of the development of the disease

Even today there is no unequivocal answer to the question: why does the symptom of drumsticks on the limbs develop and how does it develop. Medicine has established that pathology occurs through disruptions in blood microcirculation, which causes a lack of oxygen exchange in tissues. As a result, chronic hypoxia develops, which provokes the expansion of blood vessels in the toes and hands. In the phalanges, blood flow increases.

Work failures hormonal system lead to their increase by growth between the nails and bones. This increases the risk of hypoxemia, as well as endogenous intoxication. The fingers begin to thicken, acquiring rough shapes.

In persons suffering from chronic pathologies of the intestinal tract, hypoxemia does not develop. Fingers are modified in the presence of Crohn's disease in the body, exacerbation of intestinal forms of the manifestation of the disease.

What are the symptoms

Almost always, the disease develops without pain and tangible discomfort, which does not allow the patient to pay attention to the problem in time. Visible symptoms:

Over time, other signs of the disease make themselves felt. Osteoarthropathy is added to the main diseases, which is accompanied by additional row symptoms:

• Neurovascular pathology in the feet.
• Subcutaneous tissues become rough.
• The presence of pain in the skeletal system.
• Joints one or several at once are modified as in arthritis.

Diagnosis

In order to correctly determine the presence of a symptom of drumsticks, you need to contact a qualified specialist and undergo a series of studies. The presence of these criteria will help establish the diagnosis:

• When probing, there is an increased elasticity of the nail. By pressing the skin around, and then releasing, a springy effect occurs.
• The Lovibond angle is not completely visible. This can be checked with a pencil. Apply along the length of the finger, if the lumen is not visible, this will be a symptom of pathology in the phalanges.
• Excessive ratio of the entire thickness of the distal phalanx of the cuticle and the joint between the phalanges. If a person has drumstick syndrome, then the ratio will be higher than the usual norm, which is 0.895.

When diagnosing this pathology, it is necessary to determine the very cause of the onset of the disease using the following procedures:

• Routine urine and blood tests.
• Study of medical history.
• A number of ultrasound examinations: heart, liver, lungs.
• X-rays of the chest.
• Check how external breathing works.
• Determine the composition of the gas in the blood.

How to treat?

To affected fingers, first of all, you need to eliminate the cause that caused this problem. For this, doctors recommend sticking to a diet, taking drugs to strengthen the immune system, and also attribute anti-inflammatory drugs and antibiotics. By eliminating, thus, the cause, it is possible to return the limbs to their original normal appearance.