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, and liver. This ailment occurs without pain, so in the early stages it is quite difficult to identify it.
For the first time about the thickening of the terminal phalanges of the fingers of the hands learned many years ago, when it was described by Hippocrates. This explains such an unusual name for pathology. Later, doctors began to compare such a deformation of the fingers with drumsticks. The problem was studied by German and French doctors. They established the connection of "drumsticks" with the disease of hypertrophic osteoarthropathy. Already in 1918, experts called this disease a sign of chronic infections. In more detail about who has Hippocratic nails, etiology, pathogenesis and treatment, we will consider in our article.
Types of defeat
This disease has several varieties. Hippocrates' fingers develop on both arms and legs. 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 lesions:
- The bend of the fingers is like a beak of a parrot. The disease depends on the increase in the proximal part of the distal phalanx.
- Shaped watch glasses. The change occurs due to an increase in the area of tissue on the nails.
- The shape of drum sticks. An increase in tissue is observed throughout the phalanx.
Reasons for education
The most common cause of Hippocrates' nails is:
- Lung disease. In this case, the symptoms appear with: cancer or chronic lung disease, fibrotic alveolitis, bronchodilation, lung abscess, pleural empyema, cystic fibrosis.
- Heart disease. This group includes congenital heart disease and infectious endocarditis. Symptoms are accompanied by a blue type of congenital heart disease, which results in bluish skin.
- Stomach disease. Symptoms are manifested in ulcerative colitis, cirrhosis, diseases of celiac disease, Crohn's disease.
Other diseases that cause such a pathology
Hippocratic nails can signal symptoms and other diseases. This variety includes:
- Cystic fibrosis. The result of this effect is mutations and a violation of normal breathing.
- Bazedov’s disease. She belongs to the group of autoimmune diseases.
- Trichocephalosis. It is formed from parasites entering the gastrointestinal tract.
- HIV infection.
- Vibration disease.
- Diffuse ailments of connective tissue.
- Erythremia.
- Hyperthyroidism
Finger disease is usually associated with the main manifestations of the syndrome of hypertrophic osteoarthropathy, which belongs to a systemic lesion of the tubular bones. In most cases, such a syndrome is provoked by bronchogenic cancer.
Unilateral deformation
With unilateral deformation, the cause is:
- Tumor of the Pankost. 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.
- The application of arteriovenous fistula to cleanse the blood with hemodialysis.
In addition to all the causes of the disease known in medicine, there are many other sources that have not yet been discovered by scientists.
Pathogenesis and its consequences
The process of the formation of Hippocrates' nail syndrome, as mentioned above, has not yet been fully disclosed by scientists. The only accurate belief is that deformation occurs due to impaired blood flow and tissue hypoxia, which occurs from a lack of oxygen in the blood.
In case of chronic hypoxia, there is an increase in blood vessels that are in the distal phalanges of the fingers. In addition, there is an increased blood flow to such areas of the fingers. There is a version that the blood flow increases from the expansion of arteriovenous blood vessels. Their function is to bind the veins and arteries. Disclosure of arteriovenous anastomoses depends on the influence of an unknown endogenous vasodilator.
In case of violations of humoral regulation, an increase in the area of tissue occurs, which connects the nail plate to the bone. During this process, hypoxemia together with endogenous intoxication plays an important role. As a result, the final phalanges on the fingers and toes become roughened.
It is worth noting that with chronic inflammatory lesions of the intestine, hypoxemia is not observed. Finger deformity is found not only in Crohn's disease, but also in other gastrointestinal pathologies.
Symptoms
Basically, with Hippocratic disease, there is no pain that could signal the onset of the problem. Often a person does not notice the onset of the development of a symptom of drumsticks and watch glasses.
Visible signs include:
- A seal appears on the last phalanges of the fingers, as a result - the absence of a normal angle between the base of the finger with the finger fold. Basically, such changes are clearly visible on the hands, since the skin near the nail becomes loose and heterogeneous.
- Symptom of Shamrot, in which the cracks disappear. In normal condition, they appear between the nails if you put your nails on different hands. The nail plate loses its elasticity. In addition, over time, new signs of the disease form.
- The curvature of the nail bed spreads over the entire area. The nail cavity is bent from all sides.
- At the beginning of nail growth, friability of the tissue increases.
- Appears elasticity of the nail plate during palpation.
- Tissue densification occurs at the fingertips.
- A neurovascular pathology is formed in the feet.
- Coarsening of the subcutaneous tissue.
- Pain sensation in the skeletal system appears.
- The joints begin to change as with arthritis.
With the growth of tissue at the base of the nail, its visual similarity to watch glasses is noticed.
Symptoms caused by diseases
Often with diseases such as bronchiectasis, lung abscess, cystic fibrosis and chronic empyema, symptoms of hypertrophic osteoarthropathy are added to the hippocrates nails. For this disease, the following is becoming the norm:
- There is aching bone pain, which may intensify. Pain also occurs during palpation.
- In the pretibial region, the skin becomes shiny, thickened and warm.
- There is a deformation of the elbow, wrist, knee and ankle joints, one or several. They become symmetrical arthritic like in shape.
- Coarsening of the subcutaneous tissues in the area of the distal arms and legs, in some cases the face, is observed.
- The formation of neurovascular disorders of the feet or hands.
The period of onset of symptoms directly depends on the disease that provoked them. Abscess of the lung as a result leads to the elimination of the angle of Lovibond and to the balloting of the nail after ten days after the ingestion of a foreign substance into the lung.
Diagnostics
If Hippocrates syndrome develops on the basis of Marie-Bamberger disease, doctors determine the diagnosis based on such manifestations:
- There is no Lovibond corner. This fact is easy to detect. All that is needed 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 Shamrot, 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, click on the skin that is under the nail itself, then release it. If the doctor sees that the nail from such an effort plunges into the tissue, and after removing the load (the doctor’s finger) springs back, then they conclude that there is a Hippocratic disease (this result can be in people who do not have this syndrome, as well as in elderly people , therefore, a sign of elasticity of the nail is not decisive).
- A large ratio between the thickness of the distal phalanx in the area of the cuticle and the interphalangeal joint. In the normal state of nails and joints, it should be about 0.895. In a patient suffering from the disease in question, the ratio is 1.0 or higher. In most children (about 85%), this figure is higher than 1.0 for cystic fibrosis and only 5% for bronchial asthma.
When doctors have an assumption that the disease of the fingers and nails proceeds together with hypertrophic osteoarthropathy, in this case a number of additional studies are carried out, which include scintigraphy and bone radiography.
What research should be done
The diagnosis depends on the following studies, which include:
- Radiation history.
- Complex ultrasound of the heart, liver, lungs.
- Chest x-ray.
- An ECG and CT are performed.
- The breathing is studied in detail.
- The composition of the gas in the blood is determined.
Only after examination by a specialist and conducting these tests, you can prescribe a treatment that is selected individually.
Hippocrates Nail Treatment
It is very important to consult a specialist in time to determine the degree of this disease. All this can be done with the help of modern diagnostics. Thanks to additional tests and examinations, the doctor makes a diagnosis and prescribes appropriate therapy. First of all, they are struggling with the main causes of the disease. Basically, the patient is prescribed to undergo a full course of treatment, which includes drug therapy and diet. Antibacterial, anti-inflammatory or immunomodulating agents may be prescribed. For a speedy recovery, it is advisable to consult a nutritionist who will tell you which foods you must eat and which ones you need to exclude from the diet.
Forecast
The result of treatment depends on the cause of the Hippocrates 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 reduction in symptoms, but also its complete disappearance is permissible. That is, the fingers of a person get the same look. such a forecast is allowed for finger-drumsticks, and for nail-watch glasses.