Drumsticks. Fingers drum sticks on hands nails drum sticks

Have you ever seen such unusual fingers? It looks like thickening fingertips and rounding nails. At the same time, it seems to the touch that the nail is poorly held and a little "floats." These are the fingers-drum sticks or, as they are also called, "hour glass". In English literature, the term "Clubbing" is most often found. Their historical name is "Hippocratic fingers." You probably could see such elderly men, but sometimes they are found in persons young age. It is the opinion that their development is associated with severe physical labor, however, this assumption is a myth.

The main reason for the occurrence of such a phenomenon is hypoxia tissues. But to this day it is not clear why nature came up with such a strange answer to hypoxia - what function he carries. In addition, it is not entirely clear why not with all diseases associated with hypoxia develop a similar state.

Common delusion is the assumption that for development this symptom Requires years. In fact, the fingers-drum wands can be formed in just a couple of weeks. Unfortunately, reverse development in this case is practically no (even after curing the underlying disease).

Here is a list of the most common causes of these mysterious fingers:

Vices of the heart . But not minor developmental anomalies, such as open oval windowAnd real serious vices, mostly "blue type".

Infectious endocarditis - Inflammation of the inner shell of the heart, often accompanied by the formation of acquired heart defects.

Lung disease. Most often that chronical bronchitis Smokers or another version of COPD (chronic obstructive lung disease). But, if fingers appeared, this suggests that it has long been time to start treatment, including inhaliamentary therapy, etc. These include all types of oncology of the lungs, interstitial diseases, including alveolitis.

Pathology of the gastric-intestinal tract: celiac disease, Crohn's disease, ulcerative colitis.

Cirrhosis.

Hyperthyroidism.

HIV.

Hypertrophic osteoarthropathy.

And a considerable list of rare causes.

For many diseases, a natural question arises: where is hypoxia? Probably, most of them are associated with systemic inflammation and phenomena of tissue hypoxia, secondary to metabolic disorders.

The main thing!

Fingers-drum wands, with rare exception, almost never have an independent unit and always indicate serious diseases. Therefore, the detection of this symptom requires good diagnosis and identifying a real reason!

And finally, a small case of personal practice.

Already being a cardiologist, on one of the family feasts, I noted the presence of fingers in the form of drum sticks at one of your relative. It was known that he had a heart surgery in his childhood. Then I clarified at his mom that in childhood the boy was diagnosed with the "Defect of the interventricular partition" and at the age of about three years it was operated on. The defect of the interventricular partition is congenital vice "Blue" color, which should be closed in a short time.

In my head everything came out! Low growth low muscle mass, Blue lips, fingers - drum sticks. It means that the defect is closed late and remained light hypertension Or, even worse, the defect will not be covered completely.

By the way, after surgery, echocardiography has not been fulfilled. Yes, and on account of the cardiologist, a boy for some reason did not stand.

In full confidence that there will be something bad on echocardiography, I sent him to research ... and nothing! There is no residual defect, there are no residual phenomena, the vice is well closed and the heart looks great!

However, in the course of further surveys, another pathology was identified - heavy COPD against the background of a long seniority of smoking.

This example, on the one hand, confirms the connection of the described symptom with hypoxia and COPD, and, on the other hand, illustrates that sometimes it happens that the most obvious reason is not always true.

The first mention of the modified, excessively enlarged nails are still at the hippocratic. "Father of Medicine" described them as one of the symptoms of empya, the accumulation of pus. Today, pathology, called "drum sticks" (on the shape of fingers) or "glasses of hours" (on the form of nails), is considered a sign of a number of various diseases. Why does a symptom occur and is it possible to stop the development of pathology, says MedaboutMe.

The symptom of drum wands is diagnosed if the patient has a noticeable increase in the distal (nail) phalanx of the fingers. It is important to note that with such pathology they grow exclusively soft fabrics, bones remain unchanged. The deformation affects both nails - they gradually acquire a round shape, begin to resemble glasses of hours. Soft fabrics in nail phalanges grow up, as a rule, evenly, and this additionally deforms the nail plate - it becomes convex, is curved.

A characteristic sign of pathology is the change in the angle of Lovibonda. Normally, a person has a hole between the finger fold and the base of the finger, it is clearly visible if the nails have a right and left hand (a diamond clearance appears) or just attach a pencil to the finger (visible). In patients with symptom of drum sticks, soft fabrics at the base of the nail are thickened, and this bend disappears.

With the help of palpation, you can detect mobility and at the same time the elasticity of the nail plate. That is, she sends when pressed, but as soon as the impact stops, springs back.

Causes of symptom: increased blood flow

As already mentioned nail phalanxes The fingers are deformed by increasing soft tissues. Such pathological growth is directly related to circulatory disorders. During surveys, it is confirmed that these sections stick to greater powerThe vascular grid grows here, the vessels are expanding. Hypoxia is the main cause of such changes - oxygen starvation of fabrics, which is compensated by the body by increasing the area of \u200b\u200bvessels. Therefore, the symptom is characteristic, first of all, for diseases of the heart and lungs.

However, this is not the entire list of diseases in which pathology is detected. For example, in Crohn's disease, the body does not suffer from hypoxia, but the patients still develop a deformation of the fingers along the type of drum sticks.

At the same time, with even a sufficiently substantial shortage of oxygen in the blood in some patients, fingers and nails are modified in their hands, but they can remain without deformations on the legs. In the other patients, the process captures all limbs.

Therefore, today doctors call hypoxia one of the main reasons for the development of the symptom, but far from the only one. To establish all possible starting mechanisms for the development of pathology yet. In this case, the list when "drum sticks" are a characteristic symptom, Known is good.

The defeat of the respiratory organs is the most extensive group of diseases in which the symptom of watch windows is observed. Deformation S. different speedDepending on how much breathing is impaired. So, for example, with an abscess easy Education Drum sticks are noticeably after 10 days, and with chronic lesions of the alveoli (Alveolitis), the symptom develops gradually, sometimes for years.

Excessive growth of the vascular grid in the fingers is noticeable if the respiratory organs suffer from various suppurations, both sharp and sluggish, protracted. The deformation of the phalange of the fingers is observed including the bronchiectatic disease - a chronic valve process, which leads to the functional lesions of the bronchi. Most often, this pathology arises as a complication of other diseases, including:

• Chronical bronchitis.
• Tuberculosis.
• Pneumophibrosis.
• Pneumoconiosis.

Nails in the form of watch glasses - a symptom of widespread chronic obstructive lung disease. COPD is a severe lesion at which an irreversible disruption of the respiratory function is observed. The World Health Organization mentions the disease among the most common causes of death around the world.

Also, the symptom of drum sticks is characteristic of patients with tumors in respiratory tract, including it manifests itself with such diagnoses:

• Bronchogenic lung cancer.
• Small flower cancer.
• Metastasis in the lungs.

Heart disease and vessels

For adequate blood saturation with oxygen, not only respiratory authorities are answered, but also the cardiovascular system. Hypoxia develops in heart failure when myocardia is not able to pump the necessary blood volumes. Against this background, congestive phenomena arise, fabrics suffer from lack of oxygen. At the same time, the symptom of glasses of clocks is not characteristic of all heart disease and vessels. For example, with cardiomyopathy (growing and deformation of the heart muscle) or arterial hypertension (Increased arterial pressure) Nail plates and phalanges of fingers do not change. But infectious lesions can lead to strain - such heart diseases as endocarditis, often manifest themselves with excessive growth of the vascular grid in distal Falang.ah fingers.

"Hour glasses" in children is one of the classic signs of heart-type heart defects, in which various degrees of hypoxia develop. Pathology is observed at:

• Tetrade Falo.
• Anomalies connecting pulmonary veins.
• Transposition of trunk vessels.
• Atresia of the trilateral valve.

"Drum wands" with other diseases

The characteristic deformation of the nails is observed in diseases that are not related to the heart and respiratory system. Other reasons for the symptom of watch chapters:

• Diseases gastrointestinal tract - Crohn disease, gluten insufficiency, tricocephalosis (helminths in digestion organs), regional enteritis, ulcerative colitis.
• Liver diseases, first of all cirrhosis.
• Eritremia (one of the options of leukemia, blood damage).
• Basedova disease.
• Genetic pathology -, hereditary primary hypertrophic osteoarthropathy.

Symptom of glasses of hours is sometimes developing under influence external factors. So, he is observed in people who for a long time were in high mountainous areas, as well as a sign of vibration disease - professional diseaseassociated with the constant impact of vibration (work with jackhammers, behind machines and other).

It is important to note that if the "drum sticks" are not associated with chronic progressive disease, after treatment, the fingers acquire a normal form. So, for example, it is possible with such a heart disease, like an endocarditis, or after surgical intervention With heart defects. Elimination of tumors or foci of suppurations in the lungs also leads to the disappearance of the symptom.

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Symptom of drum sticks (drums, hippocratic fingers) - flaskoid thickening of the end phalanx fingers of brushes and stop with chronic diseases Hearts, lungs, liver with characteristic deformation of nail plates in the form of watch stalks. In this case, the angle that makes the rear nail roller and the nail plate, if you look at the side, exceeds 180 °. The tissue between the nail and to be subject to bone acquires a spongy character, so that when pressed on the base of the nail there is a feeling of mobility of the nail plate. In a patient with drum chopsticks, when mapping together the nails of opposing brushes between them, there is a disappearance of the gap (symptom of shamroot).

Drum fingers are not an independent diseaseAnd represent a rather informative feature of other diseases and pathological processes.

This symptom, apparently, was first described by hippocrates, which explains one of the names of the symptom of drum sticks - the fingers of the hippocratic (Digiti HipPocratici).

Etiology

Pathogenesis

Clinical meaning

When this symptom appears, a complete and careful examination of the patient in order to determine the cause of its occurrence.

Patomechhanism and reasons

Fingers in the form of drum sticks (hippocratic fingers) are the result of growing connective tissue on the back surface The distal phalanges of the fingers of the hands, less often the stop, which causes the elevation of the nails taking the shape of the hour glass →; It is often accompanied by near-gas erythema. The angle between the nail plane and the nail roller is ≥180 ° (normally ≈160 °). The emergence mechanism is unknown.

1) pulmonary - cancer and other light-forming of the lungs, fibrosis of the lungs, chronic inflammatory diseases (eg Cobl, Light abscess, Empiama pleura, bronchiectase, pulmonary tuberculosis), Mukobidosis, Sarcoidosis;

2) Cardiac - congenital villocks blue hearts, bacterial endocarditis;

3) gastrointestinal diseases - Crohn's disease, nonspecific ulcerative colitis, liver cirrhosis (biliary and portal);

4) hormonal - Greivsa-Bases disease, hyperparathyroidism;

5) idiopathic fingers in the form of drum sticks.

Fingers in the form of drum sticks on both hands are usually combined with central cyanosis. Fingers in the form of drum sticks Only on one limb are the result of impaired blood circulation in this limb as a result of the open arterial flow, aneurysm (eg. Aorts or subclavian artery) Or the arteultite. May be component hypertrophic osteodistrophia (painful subloven bone neoplasm), at which they additionally occur: a tangible thickening of periosteum on the surface of bones, not covered with muscles (in the area ankle joints, wrists) and palpation pain in these places; edema, pain and symptoms of cluster fluid in the joints (most often knee, ankle, elbow); At primary form, the overall thickening of the skin may appear, which is going to the fold. The most frequent (\u003e 90%) cause of secondary hypertrophic osteodistrophy is lung cancer.

Another Hippocrat described the fingers that were similar to sticks from the drum, when studying empy. For this reason, this pathology fingers, and nails wears the name of the fingers of the hippocrat. German Doctor Eugene Bamberger and French Dr. Pierre Marie described hypertrophic osteoarthropathy in the 19th century and pointed out the presence of fingers with the nails in the form of glasses. And already in 1918, the Doctor began to recognize this symptom of the presence of chronic infection.

Fingers, similar to the playing sticks, are mainly formed on both limbs, but in some cases the pathology can affect only arms or feet separately. Such election is characteristic of heart defect in a cyanotic form, which developed in the womb of the mother, when blood with oxygen comes only in one part of the body.

Fingers, by type resembling drum sticks, differ by what they look like:

• beak parrot;
• glasses of hours;
• real sticks from the drum.

Triggers.

This pathology develops with the following diseases:

• diseases of light different origin;
• endocarditis;
• congenital defects;
• gastrointestants;
• fibrosis;
• basned Disease;
• trichetophalhesis;
• marie Bamberger Syndrome.

The reasons for which the defeat is developing only on the one hand, may be:

• pancost tumor (formed when cancer disease first segment of the lung);
• the ailments of the vessels for which lymph flows;
• use of fistula when conducting hemodialysis;
• reception of drugs of the group of angiotensin ІІ.

The reasons

The reasons for the development of the syndrome, in which the fingers become similar to the sticks of the drum, were not revealed before that day. It is only known that this pathology develops in the presence of circulatory problems. In this case, there is a disruption of tissue oxygen power.

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

Result this process It becomes a significant arrangement of connective tissue, which is between the nail and bone. It is worth noting that there is a relationship between the level of hypoxia and external changes in the shape of a nail bed.

Studies have shown that in the presence of a chronic inflammatory illness in the intestine, oxygen fasting is not noted, but the change in the shape of the fingers and the appearance of a specific nail plate in the form of a watchcaster not only develops during the disease Crown, but also may be the first sign of this ailment.

Symptoms

The manifestation in which the nails acquire the view of the hourly windows, mainly does not provoke the appearance of pain. For this reason, the patient cannot notice this change in time.

Basic signs Symptom:

In the presence of a patient bronchiectase, fibrosis, lung abscess, chronic empyaThe main symptom can be joined by osteoarthropathy on hypertrophic type, which is characterized by:

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

Diagnostics

Most often, the symptom that is manifested by nails in the form of watch windows, signals the presence of Marie-Bamberger syndrome. If this diagnosis was not confirmed, the doctor relies on compliance with such criteria:

1. The angle of Lovibonda is measured. For this, a pencil is applied along the finger to the nail. If there is no gap between the nail and pencil, then it can be no doubt that the patient has a symptom of drum sticks. Also, the decrease in the angle or its complete disappearance is determined by studying the symptom of the shamot.
2. Finger feeling to determine elasticity. To do this, click on top finger and immediately release. If the nail immersion is observed into the fabric, and after a sharp sunshine, then you can assume a disease, the symptom of which is the nails of glass. There is the same effect in elderly patients, but it is the norm and does not indicate the presence of manifestations of drum sticks.
3. The doctor checks the ratio of TDF and interphalating joint thickness. For normal state This indicator does not exceed 0.895. If the symptom is present, the 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 the symptom of drum sticks, then the doctor makes a decision to make the patient x-ray or scintigraphy.

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

• learn anamnesis;
• to do ultrasound procedure lungs, heart and liver;
• explore the results of the thoracic x-ray;
• the doctor appoints computer tomography and electrocardiogram;
• external respiratory function is investigated;
• the patient is obliged to pass the blood to determine its gas composition.

Treatment

Nail therapy in the form of watch windows begins with therapy of the main ailment. For this patient, the doctor recommends accepting:

• antibiotics;
• medicinal products to raise immunity.

Also, it will not be superfluous and revision of the diet. It is important to consult a nutritionist and find out the list of prohibited products with a given disease.

Forecast

The forecast of how nails will look like, similar to hourly glass, directly depends on what caused this pathology. If everything has already managed to cure the main disease, the symptoms decrease, and the fingers will become a normal form.