Deformation of the fingers develops with traumatic injuries, degenerative and inflammatory diseases, malformations, hereditary pathologies. It is caused by a change in the length, thickness and configuration of the phalanges or their location relative to each other, a violation of the shape of the joints, fibrous growths, swelling of soft tissues. Establishing the cause of the pathology is carried out on the basis of the data of the survey, physical examination, radiography, CT, MRI, laboratory tests. Painkillers and anti-inflammatory drugs are sometimes allowed before a diagnosis is made.
Traumatic injuries
The following injuries are the cause of deformity of the fingers:
- Injury. The finger swells, moderate pain on palpation and movements is determined. All symptoms gradually disappear after 1-2 weeks.
- Fracture. The change in shape is associated with edema or displacement of fragments. In the latter case, shortening, curvature along the axis are detected. The pain is intense, the function of the hand is sharply reduced, sometimes crepitus, pathological mobility are detected.
- Dislocation. The finger is sharply deformed in the area of the joint, movements are impossible. There is a pronounced pain syndrome.
- Subcutaneous tendon rupture. It occurs when the end of the finger (usually the index finger) strikes a hard surface. The distal phalanx flexes, the finger takes the form of a hook, and active extension is impossible.
- Frostbite. Due to significant swelling, the fingers become sausage-shaped, the hand sometimes resembles a pillow. There are intense burning pains.
Arthritis
Deformation of the fingers in the early stages occurs due to edema, in the future - due to destruction, erosion and fibrosis of the articular ends of the bones, cartilage tissue. Features of the clinical picture are determined by the type of arthritis:
- Rheumatoid. Most often, the metacarpophalangeal joints of the 2nd and 3rd fingers suffer, multiple arthritis is possible. The defeat is symmetrical. Distal joint involvement is uncommon.
- Psoriatic. The defeat is asymmetrical. All joints of the finger are involved in the inflammatory process, which, due to edema, resembles a sausage. The skin over the joints is purple-bluish.
- Gouty. The joints of the hands are more often inflamed in women. Oligo- or polyarthritis is possible. The course is paroxysmal, intense pain is combined with edema, hyperemia, and an increase in local temperature.
- Juvenile rheumatoid. Diagnosed in children under 16 years of age. Localization of inflammation is the same as in normal rheumatoid arthritis.
- Nonspecific infectious. Occurs in the form of polyarthritis. The deformity appears some time after an acute infection, due to edema, quickly disappears, the bone and cartilage structures do not suffer.
Arthrosis
Post-traumatic arthrosis affects one joint and can occur at any age. Changes gradually increase over several years, the deformation is formed in the later stages. Multiple arthrosis of the hands and fingers develop in patients of the older age group, are more often observed in the presence of a hereditary predisposition or in professional activities associated with a large load on the hands.
A special sign of arthrosis are Heberden's and Bouchard's nodes. The former are formed in the region of the distal interphalangeal joints, the latter - proximal. Heberden's nodes are often complemented by a lateral deviation, which exacerbates the deformity. With Bouchard's nodules, the fingers become spindle-shaped due to thickening. There is a symmetrical lesion involving 1 or more joints.
Finger deformity
Anomalies of development
Congenital malformations of the fingers can occur in isolation, be combined with other stigmas of embryogenesis, or be observed as part of syndromic pathologies:
- Ectrodactyly. One or more fingers are underdeveloped. Due to the median splitting, the hand often resembles a crab claw.
- Syndactyly. There is a complete or partial fusion of the fingers with each other. The shape and size of the fingers may be preserved (simple form of the disease) or changed (complex syndactyly).
- Brachydactyly. One or more phalanges are shortened. Perhaps a combination with syndactyly, rotation of the phalanges around the axis, a change in the shape of the nail plate, underdevelopment of the metacarpal bones.
- Polydactyly. On the patient's hand there are additional full-fledged, bifurcated or rudimentary fingers.
- Clinodactyly. The fingers are curved, the axis of the fingers does not coincide with the axis of the hand. The disorder is symmetrical, affecting the little fingers or little fingers and ring fingers.
- Arachnodactyly. The fingers are long, thin, characteristically curved. Deformation combined with other changes in the skeleton, as a rule, is part of syndromic pathologies: homocystinuria, Marfan syndromes, ectopic lenses, dissection and dilatation of the aorta.
Hereditary syndromes
Finger deformities are observed in a large number of diseases caused by random mutations, aneuploidy, genetic abnormalities. Alternation or combination of several defects is detected in the following syndromes:
- Andersen's syndrome: brachydactyly, clinodactyly, sometimes syndactyly.
- Cornelia de Lange syndrome: syndactyly, clinodactyly, reduced number of fingers.
- Poland's syndrome: syndactyly, brachydactyly on the side of the lesion.
- Kabuki Syndrome. It is distinguished by a particularly pronounced polymorphism. Brachydactyly, syndactyly, arachnodactyly, clinodactyly are possible.
There are a number of hereditary diseases that are characterized by one specific congenital anomaly of the fingers:
- Clinodactyly . It affects the little fingers of the hands, is observed in the syndromes of cat's cry, Russell-Silver, Down.
- Brachydactyly . It is found in diastrophic dysplasia, Aarskog-Scott and Noonan syndromes.
- Syndactyly . Detected in patients with Pfeiffer's syndrome. For Van der Vud's syndrome, a combination of syndactyly with underdevelopment of the 1st finger is typical, for Aper's syndrome - partial or complete fusion of 2nd, 3rd and 4th fingers, possibly with one common nail.
In patients with Fanconi anemia, the absence or underdevelopment of the thumb is determined, in patients with Rubinstein-Taybi syndrome, congenital expansion of the phalanges of the fingers, especially the first ones. In other cases, deformations are not observed from the moment of birth, but are formed during the life of the patient:
- Ollie's disease. Acquired increase, thickening due to the growth of cartilage tissue.
- Thimann's disease. Asymmetric aseptic necrosis of the phalanges of 2-3 fingers. Fusiform thickening is noted, then shortening of the distal phalanges, deformation of the interphalangeal joints.
- Progeria. Deformities are caused by early aging of the body, the development of osteoarthritis
- Mucopolysaccharidosis. Acquired flexion contractures become the first symptom of the disease.
- Ataxia Friedreich. Violations of the shape of the hands are associated with paresis, muscle atrophy.
- Pseudohypoparathyroidism. The phalanges are shortened, bent against the background of the destruction of bone tissue.
Hypertrophic pulmonary osteoarthropathy
GLOA (Marie-Bamberger's disease) develops in many chronic inflammatory and oncological diseases. The nail phalanges take the form of "drumsticks", the nails become like "watch glasses". GLOA is more often detected in patients older than 40-5 years. Possible reasons are:
- Neoplastic processes : peripheral lung cancer, esophageal cancer, thyroid cancer, lymphogranulomatosis, mediastinal sarcoma, pleural mesothelioma, mediastinal metastases.
- Diseases of the lungs and pleura : pleural empyema, lung abscess, chronic pneumonia, bronchiectasis, fibrosing alveolitis.
- Cardiac pathologies : infective endocarditis, "blue" heart defects.
- Gastrointestinal diseases : ulcerative colitis, Crohn's disease, chronic hepatitis, primary biliary cirrhosis.
Sometimes changes occur with cystic fibrosis and hyperthyroidism. There is also pachydermoperiostosis (primary hypertrophic osteoarthropathy), in which similar deformities of the hands are caused by an autosomal recessive hereditary pathology, and are not caused by severe disorders of the internal organs.
Other reasons
Other possible causes of the symptom include the following:
- Felon. Significant edema is noted, with deep forms, the outcome is often gross deformities caused by bone defects, joint damage.
- Syringomyelia. The fingers thicken, the skin becomes dry, rough.
- Chinga. Initially, the deformity is provoked by swelling of the joint, and as a result, osteoarthritis and ankylosis may occur.
- Chondroma. Often occurs in the phalanges. Grows slowly over several years.
- Rickets. A thickening of the interphalangeal joints ("strings of pearls") is found.
- Paresis, paralysis . The fingers are deformed due to disorders of innervation, atrophy, the predominance of traction of some muscle groups over others.
Diagnostics
Determination of the pathology that causes deformation of the fingers is carried out by orthopedic traumatologists. According to indications, patients are referred to rheumatologists, surgeons, neurologists, and other specialists. The most commonly performed diagnostic procedures are:
- Poll, inspection . During the conversation, the doctor establishes the time and circumstances of the symptom, reveals other disorders. Investigates the dynamics of the development of the disease. Determines the nature and severity of external changes, the presence of edema, skin color and temperature, joint mobility.
- Radiography . Pictures of the fingers or hand are taken in two projections. On radiographs, dislocations, fractures, phalanx configuration disorders, neoplasms, signs of inflammation and degeneration, and areas of bone melting are visualized.
- CT, MRI . Recommended for insufficient information content of X-ray examination. They allow to detail the revealed changes, to accurately determine their localization, nature and volume, to choose the optimal tactics of conservative therapy, to plan a surgical intervention.
- Laboratory tests . Required to confirm hereditary diseases, oncological and inflammatory processes, rheumatic diseases.
The examination plan for secondary osteoarthropathy depends on the characteristics of the underlying pathology. In the process of diagnosis, chest radiography, ultrasound of the abdominal organs, echocardiography, and other methods can be prescribed.
Surgical correction of finger deformity
Treatment
Help at the prehospital stage
With injuries, inflammatory processes, an elevated position of the limb is shown. Cold is applied to fractures and dislocations, fingers are fixed with a splint or bandaged to each other. Warming bandages are applied to victims with frostbite. To reduce the severity of the pain syndrome, an analgesic is given. With exacerbation of chronic inflammation, local agents are used.
Conservative therapy
Patients with injuries are reduced, immobilized with a plaster cast. In case of subcutaneous rupture of the tendon, the finger is fixed in a state of hyperextension. With frostbite, dressings are performed. The treatment plan may include the following conservative measures:
- Protective mode . It is indicated for patients with injuries, arthrosis, arthritis during an exacerbation. It is recommended to limit the load on the limb, in some cases - orthopedic devices.
- Drug therapy . More commonly prescribed NSAIDs. The list of other medicines used includes antibiotics, hormonal drugs, and means to improve blood circulation. In some cases, blockades with a mixture of local anesthetics and corticosteroids are effective.
- Non-drug methods . Apply physiotherapy, massage, exercise therapy, kinesio taping, manual therapy.
Patients with syndromic hereditary pathology, diseases of internal organs, accompanied by osteoarthropathy, are treated for the underlying disease.
Surgery
Taking into account the causes of deformations, the following operations can be carried out:
- Traumatic injuries : fixation with knitting needles, tendon suture in the absence of self-union, amputation of fingers or necrectomy for frostbite.
- Congenital anomalies : interventions for syndactyly, plastic surgery to improve the functionality and shape of the fingers.
- Arthritis : metacarpophalangeal joint replacement.
- Panaritium : opening, drainage.
- Chondromas : removal of the tumor.
In the postoperative period, antibiotics are prescribed. Carry out complex restorative measures to improve the functions of the hand.