Fingers drumsticks reasons. Drum fingers

Hippocrates' fingers (drumstick symptom) is characteristic symptom many diseases. This pathology is also called “watch glass”, since the fingers of the limbs acquire irregular shape. They become convex at the end areas, thicken, and the nail plate is rounded. Most often, fingers - drumsticks - can be seen in older people, but the development of the disease is not related to the age of the patient.

The key mechanism is hypoxia, that is, oxygen deficiency in tissues. The phenomenon is painless and does not cause discomfort, but it is almost impossible to return the fingers to their usual shape. Even if treatment of the underlying disease is successful, reverse development does not occur.

Definition and general information

The syndrome is named after the doctor who first described it and associated it with the development of diseases respiratory system: tuberculosis, empyema, abscesses and various neoplasms. Changes in the shape of the phalanges of the fingers accompanied the main symptoms of the disease or preceded their development. Today, Hippocrates' fingers are considered a sign of hypertrophic osteoarthropathy - a disease in which the mechanisms of formation of the periosteum are disrupted, and there is intense growth on it. a large number of bone tissue.

The diagnosis can be made if two symptoms are present simultaneously:

“watch glasses” - the nail plate becomes round and increases in size;
“drumsticks” - thickening distal phalanges fingers.

Hippocrates' fingers can form within a few weeks. This process can be stopped by treating the underlying pathology, but reverse development is almost never achieved.

Causes and mechanism of development

The main trigger for the formation of Hippocratic fingers is considered to be hypoxia, that is, a lack of oxygen in the tissues. It was not possible to study it in detail, but doctors have several assumptions. Thus, a decrease in the rate of blood supply to the periosteum and insufficient intake nutrients its deformation occurs. During hypoxia, compensatory reactions are activated, expansion occurs small vessels. This provokes accelerated cell division connective tissue, which underlies the formation of Hippocrates’ fingers.

The disease is more often diagnosed simultaneously on the upper and lower extremities, but its symptoms appear only on the arms or legs. It is believed that the rate of development of the disease depends on the level of deficiency of vital gases, including oxygen: the lower its supply to the tissues, the faster the deformation of the phalanges of the fingers occurs.

Initially, the causes of the pathology were considered to be chronic pulmonary infections that occur with symptoms purulent inflammation and general hypoxia. However, today a large number of diseases have been discovered that can manifest as a symptom of drumsticks. They are usually classified according to the location of the affected organ.

Diseases of the respiratory system that provoke the appearance of Hippocratic fingers are severe pathologies, dangerous to the patient's life. These include cancer, chronic progressive purulent processes, tuberculosis, the formation of bronchiectasis (local dilation of the bronchi), abscesses, empyema (accumulation of pus in pleural cavity) and others. They all also appear respiratory failure, general hypoxia, painful sensations V chest cavity and a general deterioration in health.
Diseases of the heart and blood vessels are another group of pathologies that occur with symptoms of hypoxia. Hippocrates' fingers may be signs birth defects blue type hearts. They get their name because patients have a bluish discoloration of the skin (Fallot's disease, tricuspid atresia, pulmonary vein drainage, transposition of the mitral vessels, general truncus arteriosus). And also the syndrome can accompany sluggish inflammatory diseases infectious membranes of the heart.
Diseases gastrointestinal tract may also underlie the development of Hippocratic fingers. These include cirrhosis of the liver, ulcerative colitis(inflammation of the mucous membrane of the large intestine), Crohn's disease (an inflammatory process of autoimmune origin that can manifest itself in any area digestive tract), various enteropathies.

Other pathologies have been discovered that are characterized by changes in the shape of the distal phalanges of the fingers of the upper and lower extremities. They are not related to infectious agents or with symptoms of hypoxia. These include:

Normally, there should be a gap between the base of the two nails, at the level of the cuticle - its absence indicates drumstick syndrome.

Hippocratic fingers in most cases appear on the upper and lower extremities simultaneously. However, in some cases one can notice their one-sided formation. This may be due to several phenomena:

Pancoast tumor is a specific neoplasm that is localized in the upper part of the lung;
lymphangitis - inflammatory processes in the walls of lymphatic vessels;
atriovenous fistula - a connection between an artery and a vein, can be formed artificially to purify the blood through hemodialysis for patients with severe forms of renal failure.

Hypocrates' fingers are often one of the symptoms of the Marie-Bamberger complex. This is a syndrome that manifests itself nearby characteristic features. In patients, periosteum grows simultaneously in several areas; the distal phalanges of the fingers and toes are most often affected. And also observed inflammatory reactions in the area of the terminal sections of long tubular bones(calf, elbow and radius), which is manifested by a pain reaction. The causes of Marie-Bamberger syndrome are considered to be diseases of the lungs, heart and blood vessels, digestive tract and other specific pathologies. With radical (surgical) removal of the root cause of the disease, there is a possibility of reverse development. In some cases, the condition of the periosteum returned to normal within a few months.

Symptoms

You can recognize the fingers of Hippocrates already at initial examination. Since changes are visible to the naked eye, diagnosis is aimed at clarifying the cause of the symptom. The process of formation of fingers resembling drumsticks is not accompanied by painful sensations and occurs gradually, so many patients skip the first stages of its development.

In the future, the diagnosis can be made based on several characteristic features:

compaction and proliferation of connective tissue on the distal phalanges of the fingers, this leads to the disappearance of the Lovibond angle (it is formed by the base of the nail and the surrounding tissues);
Shamroth's symptom - the absence of a gap between the bases of two nails, if they are applied to each other;
overgrowth of the nail plate;
soft fabrics located at the base of the nail bed become too soft and loose;
Ballooning of the nail - when pressure is applied to the nail plate, it becomes elastic and shock absorbent.

All measurements can be carried out at home. It is worth understanding that the appearance of Hippocrates' fingers - dangerous symptom and accompanies diseases that threaten the patient’s life. If you suspect one of the characteristic signs, you should urgently contact medical care For urgent diagnostics and treatment, despite the painlessness of the process.

Forms of the disease

The shape of the digital phalanges depends on the type of hypoxia and individual characteristics patient. More often, changes occur symmetrically and affect both the upper and lower limbs. Unilateral damage is typical for specific pathologies of the heart and lungs, in which only one half of the body suffers from hypoxia. Thus, there are several types of Hippocrates’ fingers depending on their appearance:

“parrot beak” - associated with the growth of the upper sections of the terminal phalanges of the fingers;
“hour glasses” - are formed when the connective tissue grows around the nail plate, as a result of which it becomes round and wide;
“drumsticks” - the distal phalanges uniformly thicken and increase in volume.

Thickening of the fingers is a painless process, but pathological changes may lead to inflammatory changes and pain in the periosteum area.

Diagnostic methods

The diagnosis of Hippocratic fingers can be made by simple examination. Primary diagnosis includes confirmation of the main signs of the syndrome. If it occurs in isolation from the Marie-Bamberger complex, the following aspects must be established:

absence of a normal Lovibond angle - this can be checked by leaning the front part of the digital phalanx against any flat surface, as well as by diagnosing Schamroth’s symptom;
increased elasticity of the nail plate - when pressed top part of the nail it sinks into the soft tissue and then gradually levels out;
an increase in the ratio between the volume of the terminal phalanx of the finger in the cuticle area and the interphalangeal joint, but this sign does not appear in all patients.

To determine the cause of the appearance of Hippocratic nails, full examination. It includes x-ray of the lungs, ultrasound of the heart and organs abdominal cavity, clinical and biochemical tests blood and urine. If necessary, you can examine the conditions individual organs on MRI or CT - these diagnostic methods are considered the most reliable.

You can determine the appearance of Hippocrates’ fingers yourself, but more detailed diagnostics and treatment must only take place in a medical facility.

Treatment and prognosis

Therapy methods are selected individually, depending on the cause of the appearance of Hippocratic fingers. These may include antibiotic therapy, specific agents that suppress autoimmune reactions, anti-inflammatory drugs and other medications. In some cases, surgical intervention (removal of tumors) is indicated. The prognosis depends on the success of treatment of the underlying disease, the patient’s age and individual characteristics.

Hippocrates' fingers are a symptom that may first appear in adulthood. It may progress slowly and not bother the patient for several years, but in some cases it occurs quickly. It is possible to make a diagnosis, including at home, but the cause of this symptom can only be determined based on additional research. Further treatment also differs and depends on the results of a complete diagnosis.

This subtlety of the structure of the nail bed was of interest to Hippocrates, who described the phenomenon of fingers resembling drumsticks in a patient with a congenital heart defect in the 4th century BC. This phenomenon appears as wide, somewhat thickened, smooth-surfaced and overly convex nails that resemble watch glasses. His medical specialists called "Hippocratic".

Etiological factors

Similar characteristics are observed in patients diagnosed with pathology of the cardiovascular system, congenital heart defects, and endocarditis. This condition is associated with a lack of oxygen entering the body.
Observed in chronic pulmonary tuberculosis, cancer lungs.
When there is a circulatory disorder in the extremities, the nails sometimes acquire a bluish tint or, on the contrary, become yellow, and typical transverse or longitudinal grooves appear on their surface. In some cases, the nails separate from the nail bed near the free edge and form subungual pockets or move away from the finger entirely.
They are greatly affected by scarlet fever. 7 weeks after past infection near the base of the nails, grooves, pits and ridges are formed transversely and longitudinally. With cirrhosis of the liver, the plate becomes flat, it is dotted with longitudinal grooves, and a pigmentation disorder occurs: it turns white (like an opal stone) or a frosted glass tint appears. The holes in such nails are difficult to distinguish.
Kidney pathology also contributes to the formation of thin spots: white and brown transverse stripes.
At endocrine disorders nails are generally able to separate from the bed.
A pale tint is a symptom of iron deficiency anemia.
A change in color may also occur when taking certain medicines. Change shade antimalarials, tetracyclines, preparations from silver, arsenic, mercury, phenolphthalein.
Longitudinal ridges, like chains of beads, elevations on the nail plane often occur with polyarthritis.
Excessive skin size and transverse splitting of the plate often indicate the presence of lichen planus.
Serious nail changes and changes in the skin around the bed are formed during. Point depressions form on the surface (starting from the hole). With multiple formations of the latter, like a thimble, the nail looks rough and pockmarked. In some cases, the horny plate is separated from the bed. In other variants, the nails change color (to dull, matte white), shape, and thicken.
Small dotted white spots that appear in the areas of detachment from the skin of the nail indicate: there are problems in the body that are associated with a metabolic disorder, or a lack of any vitamins. Reception vitamin complexes leads to the disappearance of granular spots as a new part of the nail grows.
IN female body During menopause, restructuring is observed. This also affects the nails, since a disorder occurs in it calcium metabolism. Reception special complex vitamins and minerals lead to the disappearance of such manifestations.
Thinning and separation of the horny plates also occurs in pregnant women during lactation.
Those who frequently visit public baths and swimming pools often encounter fungal infections of the nail plates. Cracks and wounds on the skin, a decrease in the body’s immune abilities contribute to the penetration of the fungus, which is suitable for humid microclimatic conditions. Mostly initial manifestations cloudiness appears from the outer edge of the nail plate, under which clusters of white or yellow tint appear unpleasant smell, the plate turns yellow, thickens, and exfoliates. It becomes impossible to cut the nails because they crumble so much. Medications prescribed by a dermatologist help get rid of the fungus. And in order to prevent infection, doctors recommend covering the horny plate with a specific varnish. In public showers, it is recommended to use rubber slippers, avoid walking through channels with dirty water, and wipe your feet and areas between your toes dry.
The desire to cover your hands so as not to show your nails alarms the neurologist, since the habit of biting nails is a sign of some neurological diseases. Artificial legs made of plastic material have been found for “rodents”; they are glued to loose nails. In some cases, finger massage and a warm bath can help.
Sometimes “Hippocratic” nails are hereditary or congenital, which are not associated with any pathological forms.

DRUM FINGERS(more correctly drumstick-shaped fingers) - fingers with flask-shaped thickening nail phalanges, similar in shape to drumsticks. The name “Hippocratic fingers”, sometimes used to refer to such fingers, is incorrect, since Hippocrates described changes only in nails that resemble watch glasses (see Hippocrates nail). Drum fingers found in chronic suppurative lung diseases, especially bronchiectasis, pleural empyema, cavernous tuberculosis lungs, lung cancer, congenital heart defects, subacute septic endocarditis, liver cirrhosis 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 tympanic fingers are the initial stage of pulmonary hypertrophic osteoarthropathy, described in 1890 by P. Marie. In 1891, similar changes in bones in patients with diseases of the lungs and heart were described by E. Bamberger. These changes are sometimes referred to as Marie-Bamberger disease (see Bamberger-Marie periostosis), but this is controversial. Development drum fingers with suppuration of the lungs it can occur already during the third month of the disease, and the initial changes in the distal phalanges can appear even earlier. The development of the tympanic fingers is an indicator of the transition of pulmonary suppuration to chronic process. After a successful radical surgical intervention drum fingers may be subjected to reverse development(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) has been described subclavian artery and etc.). The origin of drum fingers explained toxic effect substances absorbed from purulent and putrefactive foci, venous stagnation, reflex-trophic disorders. Rarely, drum fingers are caused by a hereditary abnormality and are not a symptom of chronic inflammatory processes in the body and congenital heart defects.

Bibliography: Diseases of the respiratory system, ed. T. Garbiński, trans. from Polish, Warsaw, 1967; Dymovich N. A. The importance of tympanic fingers in the prognosis of pulmonary suppuration, Klin, med., t. 28, No. 7, p. 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. LenhardR.E. Digital glub-bing in Hodgkin disease, Johns Hopk. med. J., v. 128, p. 153, 1971.

P. E. Lukomsky.

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

Fingers, similar to drumsticks, are mainly formed on both limbs, but in some cases the pathology can affect only the arms or legs separately. This selection is typical for heart defects 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 vary in what they look like:

parrot beak;
watch glasses;
real drum sticks.

Triggers

This pathology develops in the presence of the following diseases:

lung diseases of various origins;
endocarditis;
birth defects;
gastrointestinal ailments;
cystic fibrosis;
Graves' disease;
trichocephalosis;
Marie-Bamberger syndrome.

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

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

Causes

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

Permanent 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.

The result of this process is a significant proliferation of connective tissue, which is located between the nail and the bone. It is worth noting that there is a relationship between the level of hypoxia and external changes nail bed shapes.

Studies have shown that in the presence of a chronic inflammatory disease in the intestines, 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 generally does not cause pain. For this reason, the patient cannot notice this change in time.

Main signs of the symptom:

If the patient has bronchiectasis, cystic fibrosis, lung abscess, chronic empyema, the main symptom may be accompanied by osteoarthropathy of the hypertrophic type, which is characterized by:

bone pain;
change in characteristics skin in the pretibial region;
elbows, wrists and knees have changes very similar to arthritis;
the skin in some areas begins to become rough;
Paresthesia and excessive sweating develop.

Diagnostics

Most often, the symptom that appears 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:

The Lovibond angle is measured. To do this, apply a pencil 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 Shamroth symptom.
Feeling with your finger to determine elasticity. To do this, press on the top of the finger and immediately release. If you observe the nail sinking into the tissue, and then a sharp springing back, then you can assume a disease, the symptom of which is glass nails. The same effect occurs in elderly patients, but it is normal and does not indicate the presence of manifestations of drumsticks.
The doctor checks the ratio of the thickness of the TDF and the interphalangeal joint. For normal condition this figure does not exceed 0.895. If a symptom is present, that indicator 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.

It is important in diagnosing why the nail becomes “glassy” is to identify the main cause of development this symptom. To do this you need:

study anamnesis;
do ultrasonography lungs, heart and liver;
study the results of a chest x-ray;
the doctor prescribes computed tomography and electrocardiogram;
the function of external respiration is examined;
the patient is required to donate blood to determine its gas composition.

Treatment

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

antibiotics;
medicines to boost immunity.

It would also be a good idea to review your diet. It is important to consult a nutritionist and find out the list of prohibited foods for this disease.

Forecast

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

LESSON 21-7 SYMPTOM OF DRUMSTICKS The symptom of drumsticks (Hippocratic fingers) is a flask-shaped thickening of the terminal phalanges of the fingers of the hands, less commonly of the toes, in chronic diseases of the heart, lungs, and liver with a characteristic deformation of the nail plates in the form of watch glasses. The tissue between the nail and the underlying bone becomes spongy, causing the nail plate to feel mobile when pressure is applied to the base of the nail. This thickening accompanies various diseases, often precedes more specific symptoms of the disease. You especially need to remember the connection of this symptom with lung cancer. Drumsticks are not a symptom independent disease, but is a fairly informative sign of other diseases, pathological processes and proceeds unnoticed at first because it does not cause pain. Thickening of the terminal phalanges can develop over many years, and in some diseases within several months (lung abscess). CAUSES One of the main reasons for the formation of the drumstick symptom is the discharge of blood from right to left - getting into venous blood into the arterial bed, bypassing the lungs or ventilated areas in them, which leads to a decrease in oxygen content in the blood, the development of hypoxemia, hypoxia and, ultimately, to dilation of the vessels of the nail phalanges of the fingers. The discharge of blood is accompanied by an increase in P(A-a)O2 - the alveolar-arterial difference in the partial pressure of oxygen. Partial pressure of oxygen in arterial blood(PaO2) does not increase during inhalation of 100% oxygen (O2). The discharge of blood from right to left can be intracardiac and intrapulmonary. Intracardiac shunting of blood from right to left - direct entry of blood from the right parts of the heart to the left, most typical for congenital cyanotic heart defects (defect interatrial septum, defect interventricular septum, tetralogy of Fallot) and infective endocarditis. Intrapulmonary shunting of blood from right to left - most often occurs in diseases accompanied by impaired ventilation with normal perfusion of the alveoli. This is due to multiple scattered microatelectasis - collapse of the pulmonary alveoli due to compression of the lung, blockage of the bronchial tube (for example, mucus, tumor), as well as due to obstruction and occlusion (impaired patency) of the pulmonary capillaries. Intrapulmonary shunting of blood from right to left occurs against the background of prolonged pulmonary diseases: bronchial lung cancer, bronchiectasis, pleural empyema, lung abscess, alveolitis. Less commonly, intrapulmonary discharge of blood occurs through arteriovenous fistulas. They can be congenital (eg, hereditary hemorrhagic telangiectasia) or acquired and can occur in any organ, although they are most often found in the lungs. REFLECTION OF THE SYMPTOM OF DRUM STICKS Fig. 76a, 31 year old man. Hereditary hemorrhagic telangiectasia, recurrent nosebleeds, drumstick sign in initial stage diseases. Fig. 76b, man, cyanotic heart defect, drumstick symptom in the final stage of the disease. Link to Fig.76: https://img-fotki.yandex.ru/get/69324/39722250.2/0_14b0e0_9c7cbac9_orig Hemorrhagic telangiectasia (Osler-Weber-Rendu disease) is a disease based on inferiority vascular endothelium(vascular cells), resulting in different areas skin and mucous membranes of the lips, mouth, internal organs Multiple angiomas and telangiectasia (capillary abnormalities) are formed, which bleed. Congenital inferiority of the vessels of internal organs is manifested by arteriovenous aneurysms, which are most often localized in the lungs, less often in the liver, kidneys, spleen and contribute to the development of pulmonary-cardiac diseases. DRUM STICK SYMPTOM - indicates reduced content oxygen in tissues (hypoxia) and the development of pulmonary-heart diseases, the cause of which in this case is hemorrhagic telangiectasia. With the symptom of drumsticks, the holes on the nails are almost always enlarged (Fig. 76a and Fig. 76b). LARGE HOLES ON THE NAILS, as well as their absence, indicate a disturbance in calcium metabolism in the body. Sometimes the hole enlarges on only one finger. One of the main reasons for enlarged holes on the nails is magnesium deficiency (Fig. 75). Reference to Fig. 75.