Fingers - drumsticks most often occur in diseases of the respiratory system. They are detected in malignant tumors, some pathologies of the liver, intestines, endocrine, cardiovascular systems. Develop gradually. The disease that provoked the changes is established according to the data of the survey, external examination, radiography, CT, spirography, bronchoscopy, and other imaging, functional and laboratory studies. Treatment may include expectorants, bronchodilators, antibiotics, non-drug therapy.
Fingers - drumsticks (fingers of Hippocrates) are a characteristic deformation of the distal parts of the fingers. The nail phalanges expand like a bulb, the nails take on the appearance of watch glasses, due to changes in the subungual tissues, they become mobile when pressed. The angle between the posterior nail fold and the nail plate is more than 18 degrees.
The symptom is the most obvious sign of hypertrophic pulmonary osteoarthropathy (Marie-Bamberger's disease) - a secondary lesion of the osteoarticular system under the influence of changes in lung tissues, toxic tumor, inflammatory factors. Along with the deformity of the fingers, pain in the bones is noted. Typically symmetrical involvement of the knee, ankle, elbow, wrist, interphalangeal joints with pain, redness, swelling, stiffness, decreased range of motion.
The most common cause of finger deformity in the form of drumsticks is bronchogenic lung cancer (every third case). In the early stages, it is manifested by a dry, hacking cough. Subsequently, pain in the chest, hemoptysis, pulmonary bleeding, due to the germination of surrounding tissues and the collapse of the tumor, join. The symptom is also provoked by the following neoplasms of the respiratory system:
A characteristic feature of malignant neoplasia is the early onset and rapid progression of the symptom. Often, the fingers take the form of drumsticks, and the nails are deformed in the form of watch glasses even before other manifestations of the tumor appear. The reasons for the changes are:
Among the benign tumors that affect the shape of the fingers is atrial myxoma. The symptom is sometimes detected with extraorganic neoplasms of the retroperitoneal space, especially high-lying ones that disrupt the mobility of the diaphragm.
Fingers in the form of drumsticks
In patients with inflammatory diseases, the fingers begin to resemble drumsticks months, years, or even decades after the onset of the first signs of the disease. The time period from the onset of symptoms to the formation of deformity depends on the severity of inflammatory and destructive changes. In patients with purulent lesions, symptoms increase faster. Nails - watch glasses with the expansion of the distal phalanges are found in the following pathologies:
Along with non-specific infectious and inflammatory processes, fingers - drumsticks are provoked by tuberculosis, especially with a long course of pathology, destructive forms, and complications.
Symptoms of "watch glasses", "drumsticks" are detected in people suffering from occupational lung diseases against the background of prolonged inhalation of industrial dust. The first manifestations of the disease develop several years (sometimes decades) after the start of contact with dust, including shortness of breath, cough with a small amount of sputum, and stabbing pains in the chest. Finger deformities are formed during the progression of the process with the appearance of weakness, sweating, shortness of breath at rest. The reason is:
"Drum sticks", "watch glasses" are found in patients with cystic fibrosis. Symptoms are detected in cystic fibrosis of the lungs and a mixed form of the disease. In the first case, there are frequent bronchitis, pneumonia with lung obstruction, the development of respiratory failure. In the second, manifestations from the lungs are combined with disorders of the gastrointestinal tract.
With Kartagener's syndrome, due to the immobility of the cilia of the bronchial epithelium, recurrent pneumonia develops in children, chronic bronchitis is diagnosed by the age of 2-3 years, and bronchiectasis is formed at the age of 3-4 years, which are foci of infection, causing the development of complications. In patients suffering from widespread pulmonary hypoplasia, the symptom is due to increasing respiratory failure, associated with chronic pneumonia.
Among other pathologies of the respiratory system that cause the formation of "drumsticks" and "watch glasses", the most common is COPD. Symptoms occur in the later stages of the disease, accompanied by severe obstruction or emphysema, respiratory failure.
Other possible causes are fibrosing alveolitis and allergic alveolitis. Characteristic finger changes are found in people with chronic mountain sickness. Finally, "drum sticks" and nails resembling watch glasses are detected in patients with diffuse pneumosclerosis, regardless of the etiology of the development of this pathological condition.
Finger deformity develops with the following congenital heart defects, accompanied by severe cyanosis due to a massive discharge of venous blood into the systemic circulation:
In addition, the symptom is found in children with certain white heart defects, such as the Eisenmenger complex or isolated extensive ventricular septal defects. The time of occurrence of deformation in white and blue defects is determined by the form of pathology.
An acquired disease that provokes the rapid formation of "drumsticks" is infective endocarditis. Infectious damage to the heart is manifested by hectic fever, chills, profuse sweating, anemia, and increased fragility of blood vessels. As a result, heart defects are possible.
Fingers - drumsticks are potentiated by severe chronic diseases of the intestines and liver. Changes in the terminal phalanges, "hour glasses" are formed gradually. Observed in such pathologies as:
Other pathologies accompanied by the formation of "watch glasses" and "drum sticks" include the following diseases:
With pachydermoperiostosis, "drumsticks" are combined with increased sweating, pachydermia, and early formation of facial wrinkles. Unlike secondary osteoarthropathy, finger deformities in this disease are not caused by malfunctions of the internal organs, but by mutations in certain genes.
Inspection of the hands
Since the fingers - drumsticks in most cases are formed in diseases of the respiratory system, the patient is examined by a pulmonologist. Signs of cardiac pathology are an indication for consultation with a cardiologist, symptoms of gastrointestinal diseases - for examination by a gastroenterologist. To clarify the diagnosis, a survey, external examination, percussion and auscultation are carried out. If lung disease is suspected, the following is prescribed:
Patients with cardiac pathology are prescribed ECG, EchoCG, phonocardiography. Carry out daily monitoring, angiocardiography, probing of the heart cavities. Examination of patients with damage to the digestive system involves biochemical tests of blood and feces, a general analysis of feces. Radiography or ultrasound of the abdominal organs, barium enema, CT, MRI, colonoscopy may be recommended.
Urgent care before the arrival of doctors is necessary for hemoptysis, pulmonary hemorrhage, increased shortness of breath. The patient is helped to assume a semi-sitting position. To improve air access, unfasten clothes, open a window. In case of bleeding, an ice pack is placed on the chest or it is suggested to periodically swallow pieces of ice. When coughing, it is allowed to take antitussive drugs, with overexcitation - sedatives, with an increase in pressure - medicines with antihypertensive action.
In case of diseases of the respiratory system, it is recommended to stop smoking, avoid hypothermia and overheating, choose work that is not associated with inhalation of dust, contact with water vapor and chemicals, aerosols, and household chemicals. Increasing breathing difficulties, pulmonary bleeding, fever, signs of general intoxication are the reason for calling an ambulance.
The list of conservative measures is determined individually, taking into account the cause of the symptom. Medical therapy includes:
The list of non-drug methods includes postural drainage, oxygenation, electrophoresis, UHF, oil and alkaline inhalations. According to the indications, therapeutic bronchoscopy is performed.
In case of pathologies accompanied by deformities such as "watch glasses" and "drum sticks", the following operations are performed: