Deformity 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, edema of soft tissues. The establishment of the cause of pathology is carried out on the basis of survey data, physical examination, radiography, CT, MRI, laboratory tests. Before the diagnosis is made, the use of painkillers and anti-inflammatory drugs is sometimes allowed.
Causes of deformation of the fingers
The following injuries become the cause of deformation of the fingers:
- Bruising. The finger swells, moderate soreness is determined by palpation and movements. All symptoms gradually disappear after 1-2 weeks.
- Fracture. The change in shape is associated with swelling 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 crepitation, pathological mobility are detected.
- Dislocation. The finger is sharply deformed in the joint area, movements are impossible. There is a pronounced pain syndrome.
- Subcutaneous tendon rupture. Occurs when the end of the finger (more often – the index finger) hits a hard surface. The distal phalanx bends, the finger takes the form of a hook, active extension is impossible.
- Frostbite. Due to significant swelling, the fingers become sausage-shaped, the hand sometimes resembles a pillow. Intense burning pains are observed.
Deformity of the fingers in the early stages occurs due to edema, subsequently due to destruction, erosion and fibrosis of the articular ends of bones, cartilage tissue. The 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 lesion is symmetrical. Involvement of distal joints is uncharacteristic.
- Psoriatic. The lesion is asymmetrical. The inflammatory process involves all the joints of the finger, which, due to swelling, resembles a sausage. The skin above the joints is purplish-cyanotic.
- Gouty. The joints of the hands are more often inflamed in women. Possible oligo- or polyarthritis. The course is paroxysmal, intense pain is combined with edema, hyperemia, and an increase in local temperature.
- Juvenile rheumatoid. It is diagnosed in children under the age of 16. The localization of inflammation is the same as with ordinary rheumatoid arthritis.
- Nonspecific infectious. It proceeds in the form of polyarthritis. The deformity of the fingers appears some time after an acute infection, is caused by edema, disappears quickly, bone and cartilage structures do not suffer.
Post-traumatic arthrosis affects one joint, can occur at any age. The changes gradually increase over several years, the deformation is formed at late stages. Multiple arthrosis of the hands and fingers develop in patients of the older age group, more often observed in the presence of a hereditary predisposition or in professional activities associated with a heavy load on the hands.
A special sign of arthrosis are the nodes of Geberden and Bouchard. The first are formed in the area of the distal interphalangeal joints, the second – proximal. Heberden nodules are often supplemented by a lateral deviation that aggravates the deformity of the fingers. With Bouchard nodules, the fingers become fusiform due to thickening. There is a symmetrical lesion involving 10 or more joints.
Congenital malformations of the fingers may 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. Because of the median cleavage, 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 can be preserved (a simple form of the disease) or changed (complex syndactyly).
- Brachydactyly. One or more phalanges are shortened. 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 is possible.
- Polydactyly. On the patient’s hand there are additional full-fledged, bifurcating or rudimentary fingers.
- Clinodactyly. The fingers are curved, the axis of the fingers does not coincide with the axis of the hand. The violation is symmetrical, the little fingers or little fingers and ring fingers suffer.
- Arachnodactyly. The fingers are long, thin, characteristically curved. The deformity of the fingers is combined with other skeletal changes, as a rule, it is part of syndromic pathologies: homocystinuria, Marfan syndromes, ectopia of the lens, dissection and dilation of the aorta.
Deformities of the fingers are observed in a large number of diseases caused by random mutations, aneuploidies, genetic anomalies. Alternation or combination of several defects is detected in the following syndromes:
- Andersen syndrome: brachydactyly, clinodactyly, sometimes syndactyly.
- Cornelia de Lange syndrome: syndactyly, clinodactyly, reduction in the number of fingers.
- Poland syndrome: syndactyly, brachydactyly on the affected side.
- Kabuki syndrome. It has a particularly pronounced polymorphism. Brachydactyly, syndactyly, arachnodactyly, clinodactyly are possible.
There are a number of hereditary diseases characterized by one specific congenital anomaly of the fingers:
- Clinodactyly. It affects the little fingers of the hands, is observed in cat cry, Russell-Silver, Down syndrome.
- Brachydactyly. It is found in diastrophic dysplasia, Aarskog-Scott and Noonan syndromes.
- Syndactyly. It is detected in patients with Pfeiffer syndrome. For Van der Wood syndrome, a combination of syndactyly with underdevelopment of 1 finger is typical, for Aper syndrome – partial or complete fusion of 2, 3 and 4 fingers, possibly with one common nail.
In patients with Fanconi anemia, the absence or underdevelopment of the thumb is determined, in patients with Rubinstein-Taby syndrome – congenital dilatation of the phalanges of the fingers, especially the first ones. In other cases, deformities are observed not from the moment of birth, but are formed during the patient’s life:
- Ollier’s disease. Acquired enlargement, thickening due to the growth of cartilage tissue.
- Timann’s disease. Asymmetric aseptic necrosis of the phalanges of 2-3 fingers. There is a fusiform thickening, then shortening of the distal phalanges, deformities of the interphalangeal joints.
- Progeria. Deformity of the fingers are caused by early aging of the body, the development of osteoarthritis
- Mucopolysaccharidosis. The first symptom of the disease is acquired flexion contractures.
- Friedreich’s ataxia. Violations of the shape of the hands are associated with paresis, muscle atrophy.
- Pseudohypoparathyroidism. The phalanges are shortened, curved against the background of the destruction of bone tissue.
Hypertrophic pulmonary osteoarthropathy
HPOA (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 40-50 years. Possible causes 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, bronchiectatic disease, fibrosing alveolitis.
- Cardiac pathologies: infectious 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 autosomal recessive hereditary pathology, and are not caused by severe disorders of the internal organs.
Other possible causes of the symptom include the following diseases:
- Panaritium. There is significant edema, with deep forms, the outcome is often gross deformities caused by bone defects, joint damage.
- Syringomyelia. Fingers thicken, the skin becomes dry, rough.
- Chinga. Initially, the deformation is provoked by swelling of the joint, osteoarthritis, ankylosis may occur in the outcome.
- Chondroma. It often occurs in the area of the phalanges. It has been growing slowly for several years.
- Rickets. Thickening of the interphalangeal joints (“strings of pearls”) is detected.
- Paresis, paralysis. Fingers are deformed due to violations of innervation, atrophy, predominance of traction of some muscle groups over others.
Determination of the pathology causing deformation of the fingers is carried out by traumatologists-orthopedists. According to the indications of patients, they are referred to rheumatologists, surgeons, neurologists, and other specialists. The following diagnostic procedures are most often performed:
- Survey, inspection. During the conversation, the doctor determines the time and circumstances of the symptom, identifies other violations. Examines 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. Finger or hand shots are taken in two projections. Dislocations, fractures, irregularities in the configuration of the phalanges, neoplasms, signs of inflammation and degeneration, areas of bone melting are visualized on radiographs.
- CT, MRI. Recommended in case of insufficient information content of X-ray examination. They allow you to detail the identified changes, accurately determine their localization, nature and volume, choose the optimal tactics of conservative therapy, plan surgical intervention.
- Laboratory tests. They are 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 cavity, echocardiography, and other techniques can be prescribed.
Assistance at the pre-hospital stage
In case of injuries, inflammatory processes, the 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. In case of exacerbation of chronic inflammation, local remedies are used.
Patients with injuries are corrected, immobilization is performed with a plaster cast. With a subcutaneous tendon rupture, the finger is fixed in a state of overextension. In case of frostbite, bandages are performed. The treatment plan may include the following conservative measures:
- Protective mode. It is indicated for patients with injuries, arthrosis, arthritis in the period of exacerbation. It is recommended to limit the load on the limb, in some cases – orthopedic devices.
- Drug therapy. NSAIDs are prescribed more often. The list of other medications 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. Physiotherapy, massage, physical therapy, kinesiotaping, manual therapy are used.
Patients with syndromic hereditary pathology, diseases of internal organs, accompanied by osteoarthropathy, are treated for the underlying disease.
Taking into account the causes of deformity of the fingers, the following operations can be performed:
- Traumatic injuries: fixation with knitting needles, suture of the tendon in the absence of independent fusion, amputation of fingers or necrectomy for frostbite.
- Congenital anomalies: interventions in syndactyly, plastic surgery to improve the functionality and correct the shape of the fingers.
- Arthritis: endoprosthetics of metacarpophalangeal joints.
- Panaritium: autopsy, drainage.
- Chondromes: removal of the tumor.
In the postoperative period, antibiotics are prescribed. Comprehensive restorative measures are carried out to improve the functions of the brush.