Metacarpophalangeal joints and their pathologies. Thickening of the phalanges of the fingers Complex islet radial flap of the forearm
Sometimes this thickening is hereditary or occurs without apparent cause, but often accompanies various diseases, including congenital cyanotic heart defects, infective endocarditis, lung diseases (lung cancer, lung metastases, bronchiectasis, lung abscess, cystic fibrosis and pleural mesothelioma), and some gastrointestinal diseases (Crohn's disease, ulcerative colitis and cirrhosis of the liver).
The reasons for the development of a symptom of drumsticks are unclear; perhaps it is due to the expansion of the vessels of the distal phalanges of the fingers under the influence of humoral factors. In patients with lung cancer, lung metastases, pleural mesothelioma, bronchiectasis and cirrhosis of the liver, the symptom of clubbing can be combined with hypertrophic osteoarthropathy. In this condition, periosteal bone formation occurs in the area of the diaphysis of long tubular bones, arthralgia and symmetrical arthritis-like changes occur in the shoulder, knee, ankle, wrist and elbow joints. Diagnosis p by X-ray and bone scintigraphy.
The symptom of drumsticks is characteristic of all chronic lung infections.
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Phalanges of fingers
The phalanges of the human fingers have three parts: proximal, main (middle) and final (distal). On the distal part of the nail phalanx there is a well-marked nail tuberosity. All fingers are formed by three phalanges, called the main, middle and nail. The only exception is the thumbs - they consist of two phalanges. The thickest phalanges of the fingers form the thumbs, and the longest form the middle fingers.
Structure
The phalanges of the fingers are short tubular bones and look like a small elongated bone, in the form of a semi-cylinder, with a convex part facing the back of the hand. At the ends of the phalanges are the articular surfaces that take part in the formation of interphalangeal joints. These joints are block-shaped. They can perform extensions and flexions. The joints are well reinforced with collateral ligaments.
The appearance of the phalanges of the fingers and the diagnosis of diseases
In some chronic diseases of the internal organs, the phalanges of the fingers are modified and take on the appearance of "drumsticks" (a spherical thickening of the terminal phalanges), and the nails begin to resemble "watch glasses". Such modifications are observed in chronic lung diseases, cystic fibrosis, heart defects, infective endocarditis, myeloid leukemia, lymphoma, esophagitis, Crohn's disease, liver cirrhosis, diffuse goiter.
Fracture of the phalanx of the finger
Fractures of the phalanges of the fingers most often occur as a result of a direct blow. Fracture of the nail plate of the phalanges is usually always shrapnel.
Clinical picture: the phalanx of the fingers hurts, swells, the function of the damaged finger becomes limited. If the fracture is displaced, then the deformation of the phalanx becomes clearly visible. With fractures of the phalanges of the fingers without displacement, stretching or displacement is sometimes misdiagnosed. Therefore, if the phalanx of the finger hurts and the victim associates this pain with an injury, then an x-ray examination (fluoroscopy or radiography in two projections) should be required, which allows you to make the correct diagnosis.
Treatment of a fracture of the phalanx of the fingers without displacement is conservative. An aluminum splint or plaster cast is applied for three weeks. After that, physiotherapy treatment, massage and physiotherapy exercises are prescribed. Full mobility of the injured finger is usually restored within a month.
In case of a fracture of the phalanges of the fingers with a displacement, bone fragments are compared (reposition) under local anesthesia. Then a metal splint or plaster cast is applied for a month.
In case of a fracture of the nail phalanx, it is immobilized with a circular plaster bandage or adhesive plaster.
Phalanges of fingers hurt: causes
Even the smallest joints in the human body - the interphalangeal joints - can be affected by diseases that impair their mobility and are accompanied by excruciating pain. Such diseases include arthritis (rheumatoid, gouty, psoriatic) and deforming osteoarthritis. If these diseases are not treated, then over time they lead to the development of a pronounced deformation of the damaged joints, a complete violation of their motor function and atrophy of the muscles of the fingers and hands. Despite the fact that the clinical picture of these diseases is similar, their treatment is different. Therefore, if you have pain in the phalanges of the fingers, then you should not self-medicate. Only a doctor, after conducting the necessary examination, can make the correct diagnosis and, accordingly, prescribe the necessary therapy.
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I had only the very tip of the bone removed, about 4 mm. and now the nail phalanx is 4 mm shorter, of course, this is nothing, but it still catches the eye, and even the nail cannot really grow. With the help of what modern biotechnologies can this be cured? give a link please.
I have thinned (decreased in diameter) index finger in front of the nail plate. One gets the impression that in this place there is just a bone. The finger began to look like an irregularly shaped hourglass. finger twitches intermittently. The skin in this place is even and soft.
Possible causes are listed in the article, and the exact cause can only be determined after an examination.
The article lists those conditions that can be a sign of enlarged phalanges, and to find out for sure, you need a face-to-face consultation with a specialist (for a start, an orthopedist or surgeon).
Hello. I'm afraid not.
If the diagnosis could be made by one sentence on the Internet, it would be very convenient, but unfortunately, this is not possible. You need to see a doctor in person and undergo an examination to get an answer to your question.
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How to treat arthrosis of the fingers with the help of traditional and traditional medicine
Usually, joint diseases occur in most cases in people of mature age.
But today, due to hormonal changes in the body, you can meet many young girls suffering from arthrosis of the fingers, an inflammatory process that is localized on the joints of the hands.
Such manifestations cause discomfort to the fair sex, not only due to the cosmetic effect, but also the loss of functions. Treatment should begin immediately, even at the stage of the initial symptoms.
The concept and characteristics of the disease
Arthrosis disease - inflammation of the joint or joints - is still not exactly understood.
Scientists cannot identify the exact causes of the manifestation of this disease, although they give several hypotheses. The main hypothesis is the cause of the disease in the form of a hereditary factor.
That is, a person has a gene from birth that can lead to an inflammatory process as soon as there are grounds for this - the causes for the disease.
Arthrosis of the fingers is no exception. In this form, all inflammatory processes of the joints occur on the phalanges of the fingers.
In rare cases, the joints of the hands suffer - in this case, the disease polyarthrosis is diagnosed. The presented disease is dangerous for a person with its irreversible manifestations. So, in advanced cases, the deformation of the joint itself and the bone to which it is adjacent is diagnosed.
Such features of the disease are already unremovable, and to improve the standard of living, experts suggest performing an operation.
A sick person has a characteristic seal in the joints between the phalanges.
Causes and risk factors of the disease
The disease has the following causes for occurrence:
- the advanced age of the patient - due to the characteristic depletion and thinning of the articular cartilage;
- during a period of hormonal failure (menopause in women and other diseases), a metabolic disorder of cartilage tissue occurs;
- weakened immunity affects the exacerbation of already existing arthrosis, and also provokes its initial occurrence;
- injuries and bruises of the fingers;
- genetic features that caused deformation and other defects in the development of the joints;
- excessive physical labor, where the basis was work with the hands;
- excessive hypothermia;
- the presence of any disease, both articular and distinctive, for example, rheumatoid arthritis, gout, diabetes mellitus and others;
- metabolic disorders of the whole organism;
- transferred infectious diseases - chlamydia and others.
Stages of the disease and characteristic signs
Symptoms of arthrosis of the fingers differ significantly depending on the stage of development of the disease.
So, there are three stages, each of which manifests itself in its own way:
- The first stage is distinguished by initial signs: joint pain occurs every time with heavy loads; there is a characteristic crunch in the fingers; swelling of the joints is manifested; diagnose joint seals between the phalanges of the fingers; constant tension of the periarticular muscle tissues, which is manifested by difficulties in self-service.
- In the second stage, a person is worried about constant pain in the joints, since inflammation of the joints occurs. It is difficult for a person not only to serve himself, but also to simply move his fingers. Inflammation of the joints is always accompanied
In the photo, arthrosis of the fingers of the 3rd stage
an increase in local temperature (when probing, you can notice an increase in the temperature of the skin in the joints).
A person should contact a specialist at the first manifestations of the disease. At the first stage, the treatment of arthrosis of the fingers can completely restore the cartilage tissue and return the patient to his former standard of living.
Rhizarthrosis of the thumb
Arthrosis of the thumb has a second name - rhizarthrosis. It manifests itself quite rarely - in about 5% of all cases diagnosed with joint diseases.
In this case, the metacarpal joint is affected at the junction with the radiocarpal bone. At the site of the lesion, there is a deformation of the joint with its protrusion outward.
Diagnostics in a medical institution
Pathology is diagnosed by a visual examination by a doctor and subsequent X-ray examination.
In the picture, you can see the characteristic damage to the joints, as well as determine the stage of development of the presented disease.
Treatment methods
Treatment of the disease involves restoring the former mobility of the joints by restoring cartilage tissue by any suitable method.
Traditional medicine and effective folk methods are used here.
traditional medicine
Methods of treatment using traditional medicine directly depend on the stage of manifestation of the disease.
- Drug therapy - first of all, the specialist prescribes the intake of non-steroidal anti-inflammatory drugs to eliminate inflammation and pain. After some relief, the patient begins to take chondroprotectors - drugs to restore cartilage tissue.
- Physiotherapy - laser therapy, magnetic therapy, paraffin applications, ozocerite baths are used. Sessions are great for pain relief.
- Exercise therapy - the patient must do simple exercises to regain their former mobility. Tapping your fingers on the table engages all the joints of your fingers.
- Massage - light stroking and rubbing - a gentle massage regimen carried out by an experienced specialist.
- Diet - throughout the treatment, the patient must adhere to a low-salt diet so that the fluid does not linger in the body, and therefore does not provoke swelling and inflammation.
- Surgical intervention - the patient is carried out the removal of growths in the articular parts, and in case of arthrosis of the thumb, the joint is immobilized by installing a fixator - arthrodesis.
Traditional medicine in most cases is applied in a complex manner. The patient must comply with all the doctor's instructions in order to quickly eliminate the pain syndrome and return to the previous standard of living.
ethnoscience
Treatment of arthrosis of the fingers with folk remedies is used only to relieve pain, eliminate swelling and inflammation, since they do not stop the process of destruction of cartilage tissue that has begun and do not contribute to restoring the balance of trace elements.
In particular, the following recipes are used:
- Mix honey and salt in equal proportions. Mix the mixture thoroughly and apply it on the sore joints. Cover your hands with plastic and put on woolen mittens. Leave the compress overnight.
- A compress for the night is recommended to be made from crushed burdock leaves. They are pre-washed and passed through a meat grinder.
In addition to compresses for the treatment of arthrosis, you can use infusions and other oral formulations. Squeeze the juice from fresh celery and take 2 teaspoons three times a day.
Be careful, complications are possible!
Pathology with untimely intervention is fraught with its serious consequences.
Surgical intervention is already the result of complications of the onset of the disease, since the surgical method is used in case of deformation of the joint and adjacent bone.
Therefore, at the first manifestations of aches in the fingers, you should contact specialists for help.
Prevention methods
As a preventive measure, experts recommend eating right - eat more vegetables and fruits, do not abuse salt.
Distribute the physical load correctly so that the fingers do not take all the weight on themselves. If you have relatives with similar problems in your family, take preventive actions diligently.
Hand health directly depends on the attitude of a person to himself. In a world of hustle and bustle, you often do not find time to visit a doctor in the initial stages of a serious illness.
This kind of negligence can lead to significant problems, the elimination of which will take a long time.
Phalanges of fingers
The phalanges of the fingers of the upper extremities of a person consist of three parts - proximal, middle (main) and distal (final). The distal part of the phalanx has a clearly visible nail tuberosity. All fingers of the human hand are formed by three phalanges - the nail, middle and main. If we talk about the thumb, then it consists of two phalanges. The longest phalanges form the middle, and the thickest - the thumbs.
The structure of the phalanges of the fingers
According to anatomists, the phalanges of the fingers of the upper extremities are short tubular bones, which have the shape of a small elongated bone, in the form of a cylinder, facing the convex part to the back of the palms. Almost every end of the phalanges has articular surfaces that take part in the formation of interphalangeal joints. These joints have a block shape. They perform two functions - flexion and extension of the fingers. The interphalangeal joints are reinforced with collateral ligaments.
What diseases cause a change in the appearance of the phalanges of the fingers?
Very often, in chronic diseases of the internal organs, the phalanges of the fingers of the upper extremities are modified. They, as a rule, take the form of "drumsticks" (a spherical thickening is observed on the terminal phalanges). As for the nails, they resemble "hour hands". Similar modifications of the phalanges are noted in the following diseases:
- heart defects;
- cystic fibrosis;
- lung disease;
- infective endocarditis;
- diffuse goiter;
- Crohn's disease;
- lymphoma;
- cirrhosis of the liver;
- esophagitis;
- myeloid leukemia.
The phalanges of the fingers hurt: the main causes
Interphalangeal joints (the smallest joints in the human body) can be affected by diseases that impair their mobility. These diseases in most cases are accompanied by excruciating pain. The main causes of impaired mobility of the interphalangeal joints are:
- deforming osteoarthritis;
- gouty arthritis;
- rheumatoid arthritis;
- psoriatic arthritis.
If these ailments are not treated, then after a while they will lead to a pronounced deformation of diseased joints, a complete breakdown of their motor function, as well as atrophy of the hands and fingers. The clinical picture of the above ailments is very similar, but their treatment is different. Therefore, for people who have pain in the phalanges of the fingers, medical specialists are advised not to self-medicate, but to contact experienced doctors.
Fracture of the phalanx of the finger
Judging by the reviews of medical specialists, a fracture of the phalanges of the fingers, as a rule, occurs as a result of a direct blow. If we talk about a fracture of the nail plate of the phalanx, then it is almost always fragmented. Such fractures are accompanied by severe pain in the area of damage to the phalanx, swelling and limitation of the function of the broken finger.
Treatment of fractures of the phalanges of the fingers of the upper extremities without displacement is conservative. In this case, traumatologists apply a plaster cast or an aluminum splint for three weeks, after which they prescribe therapeutic massage, physical education and physiotherapy. In case of a displaced fracture, reposition (comparison of bone fragments) is performed under local anesthesia. A plaster bandage or a metal splint is applied for a month.
What diseases are accompanied by bumps on the phalanges of the fingers?
Bumps on the phalanges of the fingers are manifestations of many diseases, the main of which are:
The bumps that appear on the fingers of the upper extremities are accompanied by unbearable pain, which intensifies at night. In addition, there is a characteristic seal, leading to immobility of the joints, as well as limiting their flexibility.
As for the treatment of these bumps, it consists in drug therapy, therapeutic and preventive gymnastics, massage, physiotherapy procedures and applications.
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Thickening of the terminal phalanges of the fingers or toes
Thickening of the terminal phalanges of the fingers or toes is a change in the area under the nails and around the nails. The thickening of the terminal phalanges of the fingers in itself does not pose any health hazard. However, it is often a symptom of lung disease; however, many other diseases can be the cause. Thickening of the terminal phalanges of the fingers, not associated with any disease, is inherited in some families.
Symptoms
Softening nails. Nails may seem to "float" - that is, not be firmly attached;
The angle between the nails and the cuticle increases;
The last part of the finger may appear large or bulbous. It can also be warm and red;
Curved nails down, similar to the shape of the round part of an inverted spoon.
Thickening can develop quickly, often within a few weeks. They can also be easily eliminated once the cause is clear.
Causes of thickening of the terminal phalanges of the fingers or toes
Lung cancer is the most common cause of this disease. Thickening often develops due to heart and lung conditions that reduce the amount of oxygen in the blood, such as:
Heart defects that are present at birth (congenital);
Chronic lung infections in humans: bronchiectasis, cystic fibrosis (a systemic hereditary disease caused by a mutation in the cystic fibrosis transmembrane regulator gene and characterized by damage to the external secretion glands, severe disorders of the respiratory and gastrointestinal tract functions; the most common autosomal recessive potentially lethal hereditary disease in people of white race), lung abscess;
Infection of the lining of the chambers of the heart and heart valves (infective endocarditis), which can be caused by bacteria, fungi, or other infectious agents
Lung disease in which the deep tissue of the lung swells and then scars (interstitial lung disease).
Other causes of thickening of the phalanges of the fingers:
Celiac disease (or celiac disease - a multifactorial disease, indigestion caused by damage to the villi of the small intestine by certain foods containing proteins - gluten and cereal proteins close to it);
Cirrhosis of the liver and other liver diseases;
Graves' disease (diffuse toxic goiter, Graves' disease - a life-threatening disease of the thyroid gland);
Hyperactivity of the thyroid gland;
Other types of cancer, including liver and gastrointestinal tract, Hodgkin's lymphoma.
Diagnosis and treatment of thickening of the terminal phalanges of the fingers or toes
The patient should contact his doctor if he noticed a thickening of the terminal phalanges of the fingers or toes.
Diagnosis is usually based on:
Examination of the lungs and chest.
The doctor's questions to the patient may include the following:
Does he have difficulty breathing;
Do the thickenings affect the mobility of his fingers and toes;
When did this thickening first become noticeable;
Is there a bluish color in the place of thickening;
What other symptoms accompany this disease;
The following tests may be done:
Analysis of arterial blood gases;
chest CT;
Study of lung function.
There is no specific treatment for such thickening of the terminal phalanges, however, the treatment of concomitant diseases almost always leads to the elimination of these thickenings.
Thickening of the terminal phalanges of the fingers according to the type of "drumsticks"
CLINICAL CASE
A 31-year-old man with a congenital heart disease has thickened terminal phalanges of the fingers in the form of "drumsticks" since childhood (Fig.). On closer examination, a thickening of the distal phalanges in the form of "drum sticks" is visible. He is already used to living with the limitations of a congenital heart defect, and his fingers do not bother him at all.
EPIDEMIOLOGY
The prevalence in the general population is unknown:
- 2% of adult patients seeking medical care in Wales.
- 38% of patients with Crohn's disease and 15% of patients with ulcerative colitis.
- 33% of patients with lung cancer and 11% with COPD.
PICTURE. Thickening of the phalanges by the type of "drumsticks" in a 31-year-old man with congenital heart disease. Note the thickening around the proximal edge of the nail.
ETIOLOGY AND PATHOPHYSIOLOGY
The etiology is poorly understood.
Megakaryocytes and platelet aggregations infiltrate-histem blood flow; release platelet-derived growth factor from platelets, which can cause thickening of the nail bed.
DIAGNOSIS and CLINICAL SIGNS
- Usually painless.
- Altered angle of the nail (Fig.).
- Profile angle (ABC) > 180°.
- Hyponichial angle (ABD) > 192°.
- Phalanx depth ratio (BE:GF) > I
TYPICAL LOCALIZATION
- Bilateral, involving all fingers, sometimes toes.
- Rarely unilateral or involving one or more fingers.
DIFFERENTIAL DIAGNOSIS
PRIMARY THICKENING OF THE END PHALANGES BY THE TYPE OF "DRUMB STICKS"
- Pachydermoperiostosis.
- Familial thickening of the terminal phalanges according to the type of "drumsticks".
- Hypertrophic osteoarthropathy.
SECONDARY THICKENING OF THE END PHALANGES BY THE TYPE OF "DRUMP STICKS"
Secondary thickening of the terminal phalanges in the form of "drumsticks" can be caused by many diseases, including the following:
- Diseases of the gastrointestinal tract: inflammatory bowel disease, cirrhosis of the liver and celiac disease.
- Pulmonary diseases: malignant neoplasms, asbestosis, ischemic obstructive pulmonary disease, cystic fibrosis.
- Diseases of the heart: congenital heart defects, endocarditis, atrioventricular malformations or fistulas.
TREATMENT
PICTURE. Thickening of the phalanges like "drum sticks" close-up.
PICTURE. Drumstick thickening of the phalanges in a 55-year-old man with COPD. Changed angle in profile (ABC); distal phalanx depth (BE) greater than interphalangeal depth (GF)
Drum sticks symptom
The symptom of drum sticks (Hippocratic fingers or drum fingers) is a painless bulb-shaped thickening of the terminal phalanges of the fingers and toes that does not affect the bone tissue, which is observed in chronic diseases of the heart, liver or lungs. Changes in the thickness of soft tissues are accompanied by an increase in the angle between the posterior nail fold and the nail plate up to 180° or more, and the nail plates are deformed, resembling watch glasses.
General information
For the first time, the mention of fingers resembling drumsticks is found in Hippocrates in the description of empyema (accumulation of pus in the body cavity or hollow organ), therefore, such a deformation of the fingers is often called Hippocrates' fingers.
In the 19th century German physician Eugene Bamberger and Frenchman Pierre Marie described hypertrophic osteoarthropathy (a secondary lesion of tubular bones), in which “drumsticks” fingers are often observed. By 1918, doctors considered these pathological conditions to be a sign of chronic infections.
Forms
Fingers in the form of drumsticks in most cases are observed on the hands and feet at the same time, but there are also isolated changes (only the fingers or only the toes are affected). Selective changes are characteristic of cyanotic forms of congenital heart defects, in which only the upper or lower half of the body is supplied with oxygenated blood.
According to the nature of pathological changes, the fingers are distinguished as “drum sticks”:
- Resembling the beak of a parrot. The deformation is associated mainly with the growth of the proximal part of the distal phalanx.
- Reminiscent of watch glasses. The deformation is associated with tissue growing on the base of the nail.
- True drumsticks. Tissue growth occurs around the entire circumference of the phalanx.
Reasons for development
The causes of the symptom of drum sticks can be:
- Lung diseases. The symptom manifests itself in bronchogenic lung cancer, chronic suppurative lung diseases, bronchiectasis (irreversible local expansion of the bronchi), lung abscess, pleural empyema, cystic fibrosis and fibrous alveolitis.
- Cardiovascular diseases, which include infective endocarditis (heart valves and endothelium are affected by various pathogens) and congenital heart defects. The symptom accompanies the blue type of congenital heart defects, in which a bluish tint of the patient's skin is observed (includes tetralogy of Fallot, transposition of the great vessels and pulmonary atresia).
- Gastrointestinal diseases. The symptom of drum sticks is observed in cirrhosis, ulcerative colitis, Crohn's disease, enteropathy (gluten deficiency disease).
Fingers "drumsticks" can be a symptom of other types of diseases. This group includes:
- cystic fibrosis - an autosomal recessive disease that is caused by a CFTR mutation and is manifested by severe respiratory dysfunction;
- Graves' disease (diffuse toxic goiter, Graves' disease), which refers to autoimmune diseases;
- trichuriasis is a helminthiasis that develops when the organs of the gastrointestinal tract are damaged by whipworms.
Fingers resembling drumsticks are considered the main manifestation of Marie-Bamberger syndrome (hypertrophic osteoarthropathy), which is a systemic lesion of tubular bones and in 90% of all cases is caused by bronchogenic cancer.
The cause of a unilateral lesion of the fingers can be:
- Pancoast tumor (occurs when cancer cells damage the first (apical) segment of the lung);
- lymphangitis (inflammation of the lymphatic vessels);
- the imposition of an arteriovenous fistula to purify the blood by hemodialysis (used for renal failure).
There are other, little-studied and rare causes of the development of a symptom - taking losartan and other angiotensin II receptor blockers, etc.
Pathogenesis
The mechanisms for the development of drumstick syndrome have not yet been fully established, but it is known that the deformation of the fingers occurs as a result of a violation of blood microcirculation and the resulting violation of local tissue hypoxia.
Chronic hypoxia causes dilation of blood vessels, which are located in the distal phalanges of the fingers. There is also increased blood flow to these areas of the body. It is hypothesized that blood flow is increased due to the opening of arteriovenous anastomoses (blood vessels that connect arteries to veins), which occurs as a result of exposure to an unidentified endogenous (internal) vasodilator.
The result of impaired humoral regulation is the growth of the connective tissue lying between the bone and the nail plate. Moreover, the more significant the hypoxemia and endogenous intoxication, the more severe will be the modifications of the terminal phalanges of the fingers and toes.
At the same time, hypoxemia is not typical for chronic inflammatory bowel diseases. At the same time, changes in the fingers according to the type of "drumsticks" are not only observed in Crohn's disease, but often precede the intestinal manifestations of the disease.
Symptoms
The symptom of drum sticks does not cause pain, therefore, initially it develops almost imperceptibly for the patient.
Symptom signs are:
- Thickening of the soft tissues on the terminal phalanges of the fingers, in which the normal angle between the digital crease and the base of the finger disappears (Lovibond angle). Usually the changes are more noticeable on the fingers.
- The disappearance of the gap, which normally forms between the nails, if the nails of the right and left hands are compared together (Shamroth's symptom).
- Increasing in all directions curvature of the nail bed.
- Increased friability of the tissue at the base of the nail.
- Special elasticity of the nail plate during palpation (balloting of the nail).
As the tissue at the base of the nail grows, the nails become like watch glasses.
Front view Side view
There are also signs of the underlying disease.
In many cases (bronchiectasis, cystic fibrosis, lung abscess, chronic empyema), hypertrophic osteoarthropathy, which is characterized by:
- aching pain in the bones (in some cases severe) and pain on palpation;
- the presence of shiny and often thickened, warm to the touch skin in the pretibial region;
- symmetrical arthritis-like changes in the wrist, elbow, ankle and knee joints (one or more joints may be affected);
- coarsening of the subcutaneous tissues in the area of the distal parts of the arms, legs, and sometimes the face;
- neurovascular disorders in the hands and feet (paresthesia, chronic erythema, excessive sweating).
The time it takes for a symptom to develop depends on the type of disease that triggered the symptom. So, a lung abscess leads to the disappearance of the Lovibond angle and balloting of the nail 10 days after aspiration (ingress of foreign substances into the lungs).
Diagnostics
If the symptom of clubbing occurs in isolation from Marie-Bamberger syndrome, the diagnosis is made based on the following criteria:
- The absence of the Lovibond angle, which is easy to install if you attach a regular pencil to the nail (along the finger). The absence of a gap between the nail and the pencil indicates the presence of a symptom of drum sticks. The disappearance of the Lovibond angle can also be determined thanks to the symptom of Shamroth.
- Elasticity of the nail on palpation. To test for a balloting nail, press down on the skin just above the nail and then release it. If the nail, when pressed, sinks into soft tissue, and after the skin is released, springs back, suggest the presence of a symptom of drumsticks (a similar effect is observed in older people and in the absence of this symptom).
- An increased ratio between the thickness of the TDP (distal phalanx in the cuticle area) and the thickness of the interphalangeal joint. Normally, this ratio averages 0.895. In the presence of a symptom of drumsticks, this ratio is equal to or greater than 1.0. This ratio is considered a highly specific indicator of this symptom (with cystic fibrosis in 85% of children, this ratio exceeds 1.0, and in children suffering from chronic bronchial asthma, this ratio is exceeded in only 5% of cases).
If a combination of a symptom of drumsticks with hypertrophic osteoarthropathy is suspected, a bone x-ray or scintigraphy is performed.
Diagnosis also includes studies to identify the cause of the symptom. For this:
- study history;
- do ultrasound of the lungs, liver and heart;
- perform a chest x-ray;
- prescribe CT, ECG;
- explore the functions of external respiration;
- determine the gas composition of the blood;
- make a general analysis of blood and urine.
Treatment
Treatment of finger deformity by the type of drumsticks consists in the treatment of the underlying disease. The patient may be prescribed antibiotic therapy, anti-inflammatory therapy, diet, immunomodulatory drugs, etc.
Forecast
The prognosis depends on the cause of the symptom - if the cause is eliminated (cure or persistent remission), the symptoms may regress and the fingers return to normal.
The phalanx of human limbs consists of three parts: the body - the base, the proximal and distal ends, on which the nail tuberosity is located.
Each human finger consists of three phalanges, except for (it consists of two). Three phalanges - main, middle and nail. The phalanges on the toes are shorter than those on the fingers. The longest of them is on the middle finger, the thickest - on the thumb.
The structure of the phalanx of the fingers: an elongated bone, in the middle part having the shape of a semi-cylinder. Its flat part is directed to the side of the palm, convex - to the back side. At the end of the phalanx are the articular surfaces.
By modifying the phalanx of the fingers, certain diseases can be diagnosed. A symptom of drum sticks is a thickening of the terminal phalanx of the fingers and toes. With this symptom, the tips of the fingers resemble a flask, and the nails are like watch glasses. The muscle tissue that is located between the nail plate and the bone has a spongy character. Because of this, when pressing on the base of the nail, the impression of a movable plate is created.
Drum fingers are not an independent disease, but only a consequence of serious internal changes. Such pathologies include diseases of the lungs, liver, heart, gastrointestinal tract, sometimes diffuse goiter and cystic fibrosis.
A phalanx fracture occurs from a direct blow or injury and is more often open. It can also be diaphyseal, periarticular or intraarticular. The fracture is usually comminuted.
The clinical picture of the fracture is characterized by pain, swelling and limited function of the finger. If there is internal displacement, then deformation is noticeable. If there is no displacement, a bruise or sprain may be diagnosed. In any case, an X-ray examination is necessary for a definitive diagnosis.
Treatment of a fracture of the phalanx of the fingers without displacement is carried out with gypsum or an aluminum splint, which is applied when the nail phalanx is bent up to 150, the middle one - up to 600, the main one - up to 500. A bandage or splint is worn for 3 weeks. After removing the material, therapeutic exercises with physiotherapy are carried out. A month later, the working capacity of the phalanx is fully restored.
In case of displaced phalanx fractures, the fragments are compared under. After that, a plaster or metal splint is applied for 3-4 weeks. In case of fractures of the nail phalanges, the finger is immobilized with an adhesive plaster or a circular plaster bandage.
The phalanges of the toes often suffer from dislocations in the metatarsophalangeal and interphalangeal joints. Dislocations are directed to the rear of the foot, the sole and to the side.
This problem is diagnosed by a characteristic deformity, shortening of the finger or limiting its movement.
The greatest number of dislocations falls on the phalanx of the first finger, its distal part. In second place are dislocations of the fourth finger. The middle toes are much less commonly affected due to their location in the center of the foot. In the direction of dislocations are usually observed in the rear and side. The dislocation is reduced until edema develops. If the swelling has already formed, it is much more difficult to insert the phalanx into the joint.
Closed dislocations are reduced after local anesthesia. If it is difficult to set it in the usual way, then use the introduction of a spoke through the distal phalanx or the use of a pin. The procedure is simple and safe. Then they carry out traction for the injured finger along the length and counter-traction (which is carried out by the assistant) for the ankle joint. By pressing on the base of the phalanx displaced to the side, the dislocation is reduced.
For chronic dislocations, surgical intervention is needed.
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Closed fresh ruptures of the CP are the most common injuries of the extensor tendon apparatus and occur at various levels (Fig. 27.2.40). The more distally the rupture occurs, the more preserved elements of the capsule of the distal interphalangeal joint prevent the occurrence of diastasis between the end of the tendon and the place of its attachment.
Rice. 27.2.40. The most common variants of rupture of the extensor tendons at the level of the distal interphalangeal joint of the finger.
a - outside the joint capsule; b — within the joint capsule; c - detachment from the place of attachment to the distal phalanx; d — detachment with a fragment of the distal phalanx.
Conservative treatment is very effective for closed injuries. The main problem of treatment is to keep the joints of the finger in a position that ensures maximum convergence of the end of the tendon and the distal phalanx (Fig. 27.2.41, d). To do this, the finger must be flexed at the proximal interphalangeal joint and fully extended (over-extended) at the distal joint.
The latter can be easily achieved with a simple aluminum bus (Fig. 27.2.41, a-c). However, keeping the finger in flexion at the proximal interphalangeal joint is more difficult. The use of even the simplest splints requires patients to understand the task ahead of them, constantly monitor the position of the finger and the state of the splint elements, and make the necessary adjustments. If all this succeeds, then a good result of treatment is natural, provided that the period of immobilization is at least 6-8 weeks.
Rice. 27.2.41. The use of splints in the conservative treatment of closed ruptures of the extensor tendon in the region of the distal interphalangeal joint.
a, b — tire overlay options; in — appearance of a finger with the elementary tire; d - the position of the finger, in which the lateral bundles of the tendon stretch relax as much as possible (explanation in the text).
The task of the patient (and the surgeon) is greatly simplified with additional transarticular fixation of the distal interphalangeal joint with a pin for the entire period of immobilization. The technique for performing this technique is that after passing the spoke through the joint, the distal phalanx is re-extended, thereby achieving bending of the spoke (Fig. 27.2.42). At the same time, overextension in the joint should not be excessive, as this can lead to a severe pain syndrome due to tissue tension.
Rice. 27.2.42. Stages of fixation of the distal phalanx of the finger in the hyperextension position with the help of a transarticular pin.
a - applying a perforation hole on the fingertip; b - biting of the introduced knitting needle; c - hyperextension of the phalanx on the spoke.
Operative treatment. Surgical treatment according to primary indications is advisable when a significant bone fragment is torn off along with the extensor tendon. In this case, either a transosseous CP suture is performed with fixation of the bone fragment, or (if the bone fragment is large enough) osteosynthesis with a pin is added to this.
Open injuries of the extensor tendons. With open injuries of the extensor tendons in the area of the distal interphalangeal joint, any type of tendon suture can be used, and in particular, a submerged or removable suture (Fig. 27.2.43).
Rice. 27.2.43. Transosseous fixation of the extensor tendon to the distal phalanx of the finger in chronic injury.
A skin-tendon suture may also be applied (Fig. 27.2.44). It is removed after 2 weeks. In all cases, immobilization of the finger is continued up to 6-8 weeks.
Rice. 27.2.44. The use of cutaneous-tendon removable sutures for open injuries of the extensor tendon in the region of the distal interphalangeal joint (a).
b - 8-shaped seam; c - continuous continuous seam.
Old injuries. Two weeks after a closed CP injury, conservative treatment is no longer effective. In these cases, a transosseous or immersion suture is applied to the tendon. In this case, pay attention to the following technical details of the operation:
1) access is carried out so as not to damage the growth zone of the nail;
2) scar tissue between the ends of the tendon is excised;
3) the tendon suture is applied with the nail phalanx fully unbent (overbent).
It should be noted that almost any of the varieties of the tendon suture is not able to withstand the traction of the tendon of the deep flexor of the finger. Therefore, strict additional immobilization with a splint is mandatory (as with conservative treatment). That is why it is advisable to additionally temporarily transfix the distal interphalangeal joint with a pin, which immediately simplifies the postoperative treatment of the patient and makes the prognosis more optimistic.
With an unsatisfactory outcome of surgical treatment, two main options for subsequent actions are possible:
1) performing arthrodesis of the distal interphalangeal joint;
2) tendon plasty according to Iselin (Fig. 27.2.45).
Rice. 27.2.45. Scheme of tendoplasty for chronic damage to the extensor tendon in the area of the distal interphalangeal joint (according to Iselin)
Injuries to the extensor tendons at the level of the middle phalanx of the finger are only open and involve injury to one or both lateral legs of the extensor tendon stretch. If only one leg is damaged, the function of extension of the distal phalanx may be preserved. The generally accepted tactic of treatment is suturing the damaged elements of the tendon sprain with subsequent immobilization of the finger for 6–8 weeks in the position of flexion in the proximal and extension in the distal interphalangeal joints.
IN AND. Arkhangelsky, V.F. Kirillov
Among all bone fractures, the data is 5%.
Fractures of the II finger are more common, followed by the fifth finger.
In almost 20% of cases, multiple fractures of the phalanges of various fingers are observed.
More often there are damage to the main phalanges, then the nail and rarely - the middle phalanges.
Four of the five fingers of the hand consist of three phalanges - the proximal (upper) phalanx is the middle and distal (lower).
The thumb is formed by the proximal and distal phalanx.
The distal phalanges are the shortest, the proximal phalanges are the longest.
Each phalanx has a body, as well as a proximal and distal end. For articulation with adjacent bones, the phalanges have articular surfaces (cartilages).
The reasons
Fractures occur at the level of the diaphysis, metaphysis and epiphysis.
They are non-shifted or offset, open and closed.
Observations show that almost half of phalangeal fractures are intra-articular.
They cause functional disorders of the hand. Therefore, fractures of the phalanges should be considered as a serious injury in a functional sense, the treatment of which must be approached with all seriousness.
The fracture mechanism is predominantly straight. They occur more often in adults. The blows fall on the back surface of the fingers.
Symptoms
Pulsating pain, deformity of the phalanges, and in case of fractures without displacement - defiguration due to edema, which extends to the entire finger and even the back of the hand.
Fragment displacements are more often angular, with lateral deviation from the axis of the finger.
Typical for a fracture of the phalanges is the impossibility of full extension of the finger.
If you put both hands with your palms on the table, then only the broken finger is not adjacent to the plane of the table. With displacements along the length, a shortening of the finger, phalanx is noted.
For fractures of the nail phalanges
There are subungual hematomas. Active and passive movements of the fingers are significantly limited due to exacerbation of pain, which radiates to the tip of the finger and often has a pulsating character.
The severity of the pain corresponds to the site of the fracture of the phalanx.
Not only the function of the fingers is disturbed, but also the grasping function of the hand.
When tearing off the dorsal edge of the nail phalanx
When the dorsal edge of the nail phalanx is torn off (Bush's fracture) with the extensor tendon, the nail phalanx is flexed and the victim cannot actively extend it.
Intra-articular fractures cause deformity of the interphalangeal joints with axial deviations of the phalanges.
Axial pressure on the finger exacerbates pain at the site of the fracture of the phalanx. In fractures with displacement of fragments, there is always a positive symptom of pathological mobility.
Diagnostics
X-ray examination specifies the level and nature of the fracture.
First aid
Any fracture requires temporary fixation before medical intervention in order not to aggravate the injury.
In case of a fracture of the phalanges of the hand, two or three ordinary sticks can be used for fixation.
They need to be put around the finger and wrapped with a bandage or any other cloth.
In extreme cases, you can bandage the injured finger to a healthy one. If there is an anesthetic tablet available, give it to the victim to reduce pain.
The ring on the injured finger provokes an increase in edema and tissue necrosis, so it must be removed in the first seconds after the injury.
In the case of an open fracture, it is forbidden to set the bones yourself. If disinfectants are available, treat the wound and gently apply a splint.
Treatment
No offset
Fractures without displacement are subject to conservative treatment with plaster immobilization.
Fractures with displacement from the transverse plane or close to it are subject to closed simultaneous comparison of fragments (after anesthesia) with plaster immobilization for a period of 2-3 weeks.
Ability to work is restored in 1.5-2 months.
With an oblique fracture plane
Treatment is indicated with skeletal traction or special compression-distraction devices for the fingers.
For intra-articular fractures
Intra-articular fractures, in which it is not possible not only to eliminate the displacement, but also to restore the congruence of the articular surfaces, are subject to surgical treatment, which is carried out with open reposition with osteosynthesis of fragments, and early rehabilitation.
Need to remember that the treatment of all fractures of the phalanges should be carried out in the physiological position of the fingers (half-bent at the joints).
Rehabilitation
Rehabilitation for finger fractures is one of the components of complex treatment, and it has an important place in the restoration of finger function.
On the second day after the injury, the patient begins to move with healthy fingers of the injured hand. The exercise can be performed simultaneously with a healthy hand.
A damaged finger, accustomed to being in a stationary state, will not be able to bend and unbend freely immediately after immobilization is removed. For its development, the doctor prescribes physiotherapy, electrophoresis, UHF, magnetotherapy, and physiotherapy exercises.
Based on an analysis of 2147 cases of closed fractures E. V. Usoltseva found that multiple occur in 29.3% of cases. Fractures of the fingers of the left hand are more frequent than those of the right. Injuries to the index finger account for 30% and are the most common. This is followed by the middle finger (22.9%), then the thumb (19.1%), little finger (18.3%) and finally the ring finger (13.7%).
The frequency of fractures of the terminal phalanx 47%, main - 31.2%, secondary - 8.6%, and the frequency of metacarpal fractures 13.2%. Types of fractures of the bones of the hand are shown in the figure.
Rules treatment of fractures of the bones of the hand the same as for any other fractures, that is, reduction, immobilization and functional therapy. The fine structure of the hand reacts very unfavorably to changes associated with injuries and immobilization, as well as to residual bone deformities. Shortening, twisting, displacement, remaining after the union of fractures, violate not only the function of the injured finger, but the entire hand as a whole.
At repositions and hand immobilization it should be taken into account that, according to the axis of the hand, only the middle finger moves, and the remaining fingers, when bent, are directed towards the navicular bone.
Necessary accept into account that the ability to regenerate the bones of the hand is different and depends on the location of the fracture. Spongy epiphyses fuse faster (3–5 weeks) than poorly vascularized cortical diaphyses (10–14 weeks). Moberg's diagram shows the periods of immobilization required for the fusion of fragments (The long term for the fusion of the diaphysis of the II phalanx is especially striking.
With prolonged immobilization a necessary condition is the fixation of the limb in a functionally advantageous position and the creation of the possibility for movements of the undamaged parts of the hand. Otherwise, the functional state of the hand during treatment worsens.
Fractures of terminal phalanges usually heal without complications. If there is a fracture of the site (ralangi, on which the nail is located, then for immobilization, an aluminum or plaster splint should be applied to the palmar surface of the two distal phalanges. These fractures are often accompanied by a subungual hematoma, which is extremely painful and easily suppurates. Therefore, the hematoma should be removed by drilling the nail or lifting a small area of it.Trepanation should be carried out under aseptic conditions.
nail process, as a rule, undergoes fractures due to open injuries. He, along with the nail and the pulp of the finger, dislocates towards the palm. Reposition of the bone, nail and finger pulp is performed simultaneously. The nail is fixed with one or two sutures - this is the best splinting for a broken phalanx.
splintered body fractures and the bases of the terminal phalanx are often fixed with a thin bone Kirschner wire, without splinting, since only in this way sufficient fixation of the broken bone and the shortest immobilization period are ensured.
With rotational displacement, the lines of the nail plates are not parallel compared to the nail plates of the fingers of an intact hand.
On medium and basic phalanxes differ: cracks, epiphysiolysis and complete fractures.
Fracture localization may be:
a) on the head
b) on the diaphysis and
c) on the basis.
Aluminum splint (1), used in the treatment of fractures of the proximal phalanx by the conservative method according to Iselen, the splint is preliminarily modeled on the corresponding finger of a healthy hand. The apex of the splint bend should correspond to the fracture site (2), since reposition is carried out when the finger is fixed on the splint. The main joint is flexed up to 120°, the middle joint - up to 90°.
The axis of the terminal phalanx must run parallel to the metacarpal
a) Head fractures may be in the form of a transverse "Y" or "V". An intra-articular fracture of one or both condyles usually mimics a dislocation. In the presence of multi-comminuted fractures, it may be necessary to resect with subsequent arthroplasty.
b) The line of fracture of the diaphysis can be transverse, oblique, oblong and multiple. In case of a fracture of the middle phalanx, due to the displacement of the fragments, an angle is formed that is open to the rear and very rarely to the palmar side (in the case of localization of the fracture line proximal to the attachment of the tendon of the superficial flexor). With a fracture of the main phalanx, an angle is formed that is also open to the rear, since the dorsal aponeurosis, due to the action of the common extensor of the fingers of the vermiform and interosseous muscles, is strained.
Reposition of diaphyseal fractures is not difficult, however, keeping the fragments in the reduced position is not easy, especially in the presence of transverse fractures.
in) Fractures of the base of the middle and main phalanges may have a transverse "Y" or "V" shape, or may be serrated.
At treatment of fractures of the middle and main phalanges it should be remembered that satisfactory fixation of the fingers cannot be carried out without immobilization of the wrist joint. To do this, a plaster glove without fingers is applied to the hand, including the radiocarpal joint, which provides a functionally advantageous position. A volar curved wire splint is attached to the plaster glove distally from the main phalanx for a broken finger or fingers. After repositioning, the finger is fixed on the splint with an adhesive patch. If this is not sufficient, then you should resort to sticky plaster traction.
traction should not last more than three weeks. After removing it, only a protective splint is applied to prevent the displacement of fragments. With the Bunnell method, transosseous traction is used, and according to Moberg, transosseous traction is used. We consider these two methods to be incorrect. Traction with a rubber band is difficult to regulate, sometimes it is excessively strong, and in other cases it is easily weakened. This method requires constant x-ray control. The method is dangerous due to the possibility of infection and skin necrosis. The traction applied to the finger during traction treatment does not serve to reposition the fragments, but only to fix the manually repositioned bones.
a - a diagram of the displacement of fragments that occur with fractures of the middle phalanx b - diagram of displacement of fragments that occur with fractures of the main phalanx
c - displacement of fragments at an angle in the middle third of the main phalanx of the index finger, resulting from insufficiently long immobilization. The fragments form an angle of 45°, open to the rear. Ten-week-old fracture but mild callus formation
d - fracture of the main phalanx, fragments fused at an angle open to the rear, due to insufficient immobilization. Produced: osteotomy and intraosseous fixation with a Kirschner wire, after which the axis of the main phalanx is aligned
If a fixation is not achieved by applying an adhesive bandage or traction, then we resort to the method of trans- or intraosseous fixation using Kirschner wires, but in no case do we consider it acceptable to use trans-pulp traction. Transosseous wire fixation has its advantages even in the presence of open fractures. We combined it with the introduction of antibiotics, as a result of which we never observed infectious complications. Verden proposes the use of periosseous fixation with a pin. After manual repositioning, a thin Kirschner wire is inserted between the extensor tendon and the cortical layer of the bone, which prevents the fragments from moving at an angle or to the side.
According to our personal experience, in the presence of transverse fractures, such an “internal” tire is not sufficient, since it does not prevent the rotation of the distal fragment of the phalanx. To immobilize such fractures, cross-wire should be used (I. Böhler, Strehl).