The disease, which was called the fingers of Hippocrates, manifests itself in the form of edema of the terminal phalanges on the fingers or toes. Because of this, the nail plates begin to deform, arching at the ends. Often the disease manifests itself in people with problems with the lungs, heart, liver. This ailment occurs without pain, so it is quite difficult to identify it in the early stages.
For the first time, the thickening of the terminal phalanges of the fingers was known many years ago, when it was described by Hippocrates. This explains such an unusual name for the pathology. Later, doctors began to compare such a deformation of the fingers with drumsticks. German and French doctors took up the study of the problem. They established the connection of "drumsticks" with the disease of hypertrophic osteoarthropathy. Already in 1918, experts called this disease a sign of chronic infections. We will consider in more detail about who has Hippocratic nails, etiology, pathogenesis and treatment in our article.
Varietiesdefeats
This disease has several varieties. Hippocratic fingers develop on both hands and feet. There are situations when the deformation of the same person is observed on the legs and arms. Often, such changes are characteristic of people suffering from congenital heart defects.
There are such types of damage:
- The curve of the fingers is like a parrot's beak. The disease depends on the enlargement of the proximal part of the distal phalanx.
- Having the shape of watch glasses. The change happens due to the increase in tissue area on the nails.
- Shape of drumsticks. An increase in tissue is observed throughout the phalanx.
Reasons for education
The most common cause of Hippocratic nails is:
- Lung disease. In this case, the symptoms appear with: cancer or chronic lung disease, fibrous alveolitis, bronchial dilation, lung abscess, pleural empyema, cystic fibrosis.
- Heart disease. This group includes congenital heart disease and infective endocarditis. Symptoms are accompanied by a blue type of congenital heart disease, which results in blueness of the skin.
- Diseases of the stomach. Symptoms appear in ulcerative colitis, cirrhosis, celiac disease, Crohn's disease.
Other diseases that cause this pathology
Hippocratic nails can signal symptoms of other illnesses as well. To this species belong:
- Cystic fibrosis. Resultsuch impact - mutations and disruption of normal breathing.
- Graves' disease. It belongs to the group of autoimmune diseases.
- Trichocephalosis. It is formed from parasites entering the gastrointestinal tract.
- HIV infection.
- Vibration sickness.
- Diffuse ailments of the connective tissue.
- Erythremia.
- Hyperthyroidism.
Disease of the fingers is usually associated with the main manifestations of the syndrome of hypertrophic osteoarthropathy, which belongs to the systemic lesion of tubular bones. In most cases, this syndrome is provoked by bronchogenic cancer.
One-sided deformation
With one-sided deformation, the cause is:
- Pancoast tumor. It appears as a result of the formation of cancer cells in a segment of the lung.
- Lymphangitis. A disease caused by inflammation of the lymphatic vessels.
- Application of an arteriovenous fistula to purify the blood with hemodialysis.
In addition to all the causes of the disease known in medicine, there are many other sources not yet discovered by scientists.
Pathogenesis and its consequences
The process of formation of the Hippocratic nail syndrome, as indicated above, has not been fully disclosed by scientists to this day. The only certain belief is that the deformity is due to impaired blood flow and tissue hypoxia, which occurs from a lack of oxygen in the blood.
In the case of chronic hypoxia, there is an increasevessels that are in the distal phalanges of the fingers. In addition, there is increased blood flow to such areas of the fingers. There is a version that blood flow increases from the expansion of arteriovenous blood vessels. Their function is to connect veins and arteries. Opening of arteriovenous anastomoses depends on the influence of an unidentified endogenous vasodilator.
When humoral regulation is disturbed, there is an increase in the area of tissue that connects the nail plate to the bone. During this process, hypoxemia plays an important role along with endogenous intoxication. As a result, the terminal phalanges on the fingers and toes become coarse.
It is worth noting that in chronic inflammatory lesions of the intestine, hypoxemia is not observed. Finger deformities occur not only in Crohn's disease, but also in other pathologies of the gastrointestinal tract.
Symptoms
In general, Hippocratic disease does not cause pain to signal the onset of a problem. Often a person does not notice the beginning of the development of a symptom of drumsticks and watch glasses.
Visible signs include:
- There is a seal on the last phalanges of the fingers, as a result - the absence of a normal angle between the base of the finger with the digital crease. Basically, such changes are clearly visible on the hands, as the skin near the nail becomes loose and heterogeneous.
- Shamroth's symptom, in which gaps disappear. They normally appear betweennails, if you lean the nails on different hands. The nail plate loses elasticity. In addition, as time passes, new signs of the disease form.
- The curvature of the nail bed grows over the entire area. The nail cavity is curved from all sides.
- At the beginning of nail growth, tissue looseness increases.
- The elasticity of the nail plate appears on palpation.
- Tissue compaction occurs at the fingertips.
- Neurovascular pathology is formed in the feet.
- Coarseness of subcutaneous tissues.
- Pain sensitivity appears in the skeletal system.
- Joints begin to change like arthritis.
When the tissue grows at the base of the nail, its visual resemblance to watch glasses is noticed.
Signs caused by diseases
Often, in diseases such as bronchiectasis, lung abscess, cystic fibrosis and chronic empyema, symptoms of hypertrophic osteoarthropathy are added to Hippocratic nails. For this disease, the following becomes the norm:
- There is aching pain in the bones, which may get worse. There is also pain on palpation.
- Skin becomes shiny, thickened and warm in the pretibial area.
- There is a deformation of the elbow, wrist, knee and ankle joints, one or several at once. They become symmetrical, arthritis-like in shape.
- There is coarsening of the subcutaneous tissues in the area of the distal parts of the arms and legs, in some cases the face.
- Formation of neurovascularfoot or hand disorders.
The period of manifestation of symptoms directly depends on the disease that provoked them. Lung abscess results in elimination of the Lovibond angle and balloting of the nail ten days after the foreign substance enters the lung.
Diagnosis
If Hippocratic syndrome develops on the basis of Marie-Bamberger's disease, doctors determine the diagnosis based on the following manifestations:
- There is no Lovibond corner. This fact is easy to discover. All you need to do is to put a pencil along the finger to the nail. If the gap between the pencil and the finger is not observed, then this indicates the development of the fingers of Hippocrates. The absence of an angle can be established using the symptom of Shamroth, which we wrote about above.
- Take into account the elasticity of the nail during palpation. As a rule, a specialist conducts an external examination. To do this, you need to press on the skin, which is located under the nail itself, then release. If the doctor sees that the nail is immersed in the tissue from such an effort, and after removing the load (the doctor’s finger) springs back, then they conclude that there is Hippocratic disease (this result can be in people who do not have such a syndrome, as well as in elderly people, so the sign of elasticity of the nail is not decisive).
- Great ratio between the thickness of the distal phalanx in the area of the cuticle and the interphalangeal joint. In the normal state of the nails and joints, it should be about 0.895. In a patient suffering from the disease in question,the ratio is 1.0 and above. Most children (about 85%) have it above 1.0 with cystic fibrosis and only 5% with asthma.
When doctors suspect that finger and nail disease is associated with hypertrophic osteoarthropathy, a number of additional studies are performed, which include scintigraphy and bone x-ray.
What research should be done
The diagnosis is directly dependent on the following tests, which include:
- Radiation history.
- Complex ultrasound of the heart, liver, lungs.
- Chest x-ray.
- An ECG and CT is being done.
- Respiration is studied in detail.
- Determine the composition of the gas in the blood.
Only after examination by a specialist and these tests, you can prescribe a treatment that is selected individually.
Hippocratic Nail Treatment
It is very important to consult a specialist in time to determine the extent of this disease. All this can be done with the help of modern diagnostics. Thanks to additional tests and examinations, the doctor establishes a diagnosis and prescribes appropriate therapy. First of all, they are struggling with the main causes that caused the disease. Basically, the patient is prescribed to undergo a full course of treatment, which includes drug therapy and diet. Antibacterial, anti-inflammatory orimmunomodulatory agents. For a speedy recovery, it is advisable to consult a nutritionist who will tell you which foods you need to eat and which should be excluded from the diet.
Forecast
The result of treatment depends on the cause of the Hippocratic nail syndrome. If fingers, like drumsticks, appeared due to a disease that can be completely cured or transferred to the stage of solid remission, then not only a decrease in symptoms is acceptable, but also its complete disappearance. That is, the fingers of a person acquire their former form. such a prediction is allowed for fingers-drumsticks, and for nails-watch glasses.
