The human hand consists of many small joints. Thanks to this, the fingers can perform quite complex movements: write, draw, play musical instruments. The brush is involved in any everyday human activity. Therefore, various joint pathologies in this area greatly reduce the quality of life. Indeed, due to limited mobility, it becomes difficult to perform the simplest actions.

And the joints are most often affected, since this is the most vulnerable place and subject to heavy loads. Due to the structural features, inflammation, metabolic disorders or injuries may occur here. One of the most important and mobile joints of the hand is the metacarpophalangeal joint. It connects the metacarpal bones to the main phalanges of the fingers and provides mobility to the hand. Due to their location and functions, these joints are most often subject to various pathologies.

General characteristics

The metacarpophalangeal joints of the hand are spherical joints with a complex structure. They are formed by the surfaces of the heads of the metacarpal bones and the bases of the first phalanges. After the wrist joint, these are the largest and most mobile in the hand. They bear the main load during any hand work. The metacarpophalangeal joint of the thumb is slightly different due to its special structure, location and function. Here it has a saddle shape, so it is not so mobile. But it is he who is responsible for the grasping movements of the hand.

This joint can be easily seen if you clench your hand into a fist. In this case, the metacarpophalangeal joints of the four fingers form semicircular bulges, spaced approximately 1 cm from each other. The most noticeable bump is in the area of ​​the middle finger. Due to this location, these joints are very vulnerable and are quite often subject to trauma or various pathological processes. In this case, not only the work of the hand is disrupted, but also the overall performance of a person.

The metacarpophalangeal joints are the most mobile in the hand; they can bend, extend, move in the lateral plane and even rotate

Movements in the joint

This joint is the most mobile among all the joints of the hand. He has quite complex biomechanics. Fingers in this place can perform the following movements:

• flexion-extension;
• abduction-adduction;
• rotation.

Moreover, the last movements are available only for 4 fingers. The large one has a special structure - only two phalanges. Therefore, his metacarpophalangeal joint is block-shaped - it can perform a limited number of movements. It only bends; all other movements are blocked and impossible even in a passive form. This articulation of the thumb follows the form and function of all other interphalangeal joints.

The metacarpophalangeal joints of the remaining fingers are more mobile. This is explained by their special structure. The base of the phalanx is slightly smaller than the head of the metacarpal bone. Their strong connection is ensured by a fibrocartilaginous plate. On the one hand, it serves for tight contact between the bones and stabilization of the joint, which is especially noticeable when extending the finger. But when he starts to move, this plate slides, providing a greater range of motion.

A feature of this joint, due to which the finger can move in different directions, is the elasticity of its capsule and synovial membrane. In addition, the joint capsule has deep pockets in front and back. They ensure the sliding of the fibrocartilaginous plate, and it is in these places that the tendons of the muscles that control the operation of the fingers are attached.

Greater mobility of these joints is possible due to the presence of two types of ligaments. One is attached to the fibrocartilaginous plate and the head of the metacarpal bone. It ensures normal sliding of this plate. Other ligaments are collateral, located on the sides of the fingers. They ensure their flexion and extension, and also slightly limit the mobility of the joint. For example, with a bent finger, its movement in the lateral plane, that is, its abduction and adduction, is impossible. The operation of this joint is also controlled by the palmar ligament and the transverse interdigital ligament.

Unlike the thumb, which bends less than 90 degrees at the metacarpophalangeal joint, the other fingers have a greater range of motion. The index finger has the least mobility; it can bend 90-100 degrees, no more. Further to the little finger, the range of movements, especially passive ones, increases. And the middle one cannot bend more than 90 degrees even passively due to the tension of the interdigital ligament, which prevents it from approaching the palm.

The metacarpophalangeal joints are the only ones in the hand that can be extended, although with a small amplitude - no more than 30 degrees. Although in some people the mobility of the fingers can reach such an extent that they extend at a right angle. In addition, in this place it is possible to perform rotational movements, both passive and active. But their mobility is different for each person.

It is in these places that pain most often occurs due to age-related changes in tissues, after increased stress or other pathologies

Features of pathologies

Due to such a complex structure of the metacarpophalangeal joints and a large range of movements, they are most often subject to injuries and various pathologies. Pain in this area may be associated with damage to the articular capsule, the surface of the bone heads, the cartilaginous plate or ligaments. They make it difficult to move the hand and lead to serious problems when performing normal activities. Therefore, you should not ignore the first symptoms of pathologies; the sooner treatment is started, the faster hand function will be restored.

Such diseases most often occur in people after 40 years of age, which is associated with age-related changes in tissues and the consequences of increased stress. Moreover, women are most susceptible to damage to the joints of the hand. After all, during menopause, hormonal changes occur in their bodies, which negatively affects the functioning of the entire body. In addition, pathologies of the metacarpophalangeal joints can occur due to injuries, increased stress, hypothermia or infectious diseases.

If you experience pain in your hand, you should definitely consult a doctor for examination and an accurate diagnosis. After all, the treatment of different diseases is different, but their symptoms can often be the same. It is worth visiting a doctor if there is pain when moving your finger or at rest, swelling, redness of the skin, or limited movement of the hand.

After diagnostic procedures, one of the following pathologies is usually detected:

• rheumatoid arthritis;
• psoriatic arthritis;
• infectious arthritis;
• osteoarthritis;
• gout;
• stenosing ligamentitis;
• inflammation of soft tissues;
• injury.

These joints are often affected by arthritis, causing pain and inflammation

Arthritis

Most often, the fingers are affected by arthritis. This is an inflammatory disease that affects the joint cavity. Arthritis can occur as a complication after a general infectious disease, injury, or as a result of pathologies of the immune system. The joints of the fingers can be affected by rheumatoid arthritis, psoriatic or infectious. Common symptoms of these diseases are pain, swelling, flushing and limited mobility.

But there are differences between different types of arthritis. The rheumatoid form of the disease is characterized by a chronic course and symmetrical lesions of the fingers on both hands. With psoriatic arthritis, inflammation of just one finger may develop. But all his joints are affected. At the same time, it swells and becomes like a sausage.

In infectious arthritis, inflammation is associated with the entry of pathogenic microorganisms into the joint cavity. Mainly one joint is affected. There is a tugging pain, often very severe, swelling, and a rise in temperature. Sometimes pus accumulates in the joint cavity.

Arthrosis

Chronic degenerative joint disease is arthrosis. It usually develops in several places at once, but often affects the base of the fingers. This pathology is characterized by aching pain that occurs after exercise, joint stiffness, and deformation. All this leads over time to the inability to perform basic movements with the fingers: fasten buttons, hold a spoon, write something.

Arthrosis affects cartilage tissue, leading to its destruction. Therefore, the metacarpophalangeal joint with this pathology can quickly lose mobility. After all, its peculiarity is that a large range of movements is ensured by the sliding of the fibrocartilaginous plate. And when it is destroyed, the joint is blocked.

Sometimes rhizarthrosis occurs, in which the first finger is isolated. The reasons for the destruction of cartilage tissue in this place are regular increased loads on it. Rhysarthrosis must be differentiated from gout or psoriatic arthritis, the symptoms of which are similar, but their treatment is very different.

Destruction of cartilage tissue during arthrosis leads to severe deformation of the joints

Gout

This is a pathology of metabolic processes, as a result of which the accumulation of uric acid in the blood and the deposition of salts in the joints begins. Gout usually affects the metatarsophalangeal joints on the foot, but in women it can also occur on the big toes.

The disease develops in attacks. During an exacerbation, a sharp, severe pain occurs in the joint, it swells and turns red. It becomes impossible to touch it or move your finger. Usually the attack lasts from several days to a week. Gradually, gout can lead to joint deformation and complete immobility.

Ligament inflammation

If the annular ligament of the fingers is affected, they speak of the development of stenotic ligamentitis. The main symptoms of the pathology resemble arthrosis - pain also occurs when moving. A characteristic feature of the disease is clearly audible clicks when moving, and sometimes jamming of the finger in a bent position.

Similar to this pathology is tendinitis - inflammation of the collateral or palmar ligaments. But its peculiarity is that the finger gets jammed in an extended position; often the patient cannot bend it on his own.

The metacarpophalangeal joint is very vulnerable, especially on the big toe

Injuries

Injuries to the metacarpophalangeal joints are common. Athletes are especially susceptible to them, but you can injure your hand even when doing homework with careless movement. The most common injury in this area is a bruise, which is accompanied by severe pain and the development of a hematoma. It hurts to move your finger, but all symptoms most often go away quickly even without treatment.

A more serious injury is a dislocation. The metacarpophalangeal joint can be injured when it is hyperextended, for example during sports or a fall. In this case, severe pain occurs, the joint becomes deformed and swells. Quite often, dislocation of the thumb occurs, since it is subjected to the greatest loads. And pitting it against the rest of the brush makes it vulnerable.

Treatment

When treating pathologies in this place, it should be remembered that immobilization of the metacarpophalangeal joints can only be carried out in a flexion position. Indeed, due to the peculiarities of the collateral ligaments, their long-term fixation can lead to finger stiffness in the future. Therefore, if immobilization is necessary, for example, after an injury, you need to do it correctly. It is best to use a ready-made orthosis or a bandage applied by a doctor. But otherwise, diseases of these joints are treated in the same way as similar pathologies in other places.

Most often, patients go to the doctor because of painful sensations. To get rid of them, NSAIDs or analgesics are prescribed. These can be “Baralgin”, “Trigan”, “Ketanov”, “Diclofenac”. Moreover, they can be used both internally and externally in the form of ointments. For severe pain, injections are sometimes made directly into the joint cavity. And in advanced cases, corticosteroids can be used.

When cartilage tissue is destroyed, the use of chondroprotectors is effective. At the initial stage, they are able to completely stop tissue degeneration. Sometimes joint damage and metabolic disorders in them are associated with circulatory pathologies. In this case, Actovegin, Vinpocetine or Cavinton may be prescribed. These drugs improve blood circulation and nerve conduction, and also accelerate tissue regeneration processes. If the inflammation is caused by an infection, antibiotics must be used: Ofloxacin, Doxycycline, Cefazolin and others.

When treating these pathologies, it is especially important to relieve pain, which greatly reduces the performance of the hand.

After pain and inflammation disappear, auxiliary treatment methods are prescribed to restore finger mobility. These can be physical procedures, for example, magnetic therapy, mud applications, paraffin, acupuncture, electrophoresis. Therapeutic exercises for the fingers are also useful, since prolonged immobilization can lead to muscle atrophy. Special exercises prevent the development of stiffness, improve blood circulation and tissue nutrition.

The metacarpophalangeal joints are the most important for the normal functioning of the hand. But injuries and various pathologies affecting this joint can lead to a complete loss of its functionality.

Fractures of the distal phalanges divided into extra-articular (longitudinal, transverse and comminuted) and intra-articular. Knowledge of the anatomy of the distal phalanx is important for the diagnosis and treatment of these types of injuries. As shown in the figure, fibrous bridges are stretched between the bone and skin to help stabilize the distal phalanx fracture.

In the space between these jumpers, a traumatic hematoma, causing severe pain due to increased pressure inside this enclosed space.
TO distal phalanges of fingers II-V two tendons are attached. As shown in the figure, the deep flexor tendon is attached to the palmar surface, and the terminal portion of the extensor tendon is attached to the dorsal surface. If too much force is applied, these tendons can tear off. Clinically, there is a loss of function, and radiologically, minor avulsion fractures at the base of the phalanx can be detected. These fractures are considered intra-articular.

Mechanism of damage in all cases there is a direct blow to the distal one. The force of the impact determines the severity of the fracture. The most typical fracture is a comminuted fracture.
At inspection Usually there is tenderness and swelling of the distal phalanx of the finger. Subungual hematomas are often observed, indicating a rupture of the nail bed.

IN diagnostics fracture and possible displacement, images in both direct and lateral projections are equally informative.
As mentioned earlier, it is often observed subungual hematomas and nail bed tears. Often, in combination with a transverse fracture of the distal phalanx, incomplete separation of the nail is observed.

Treatment of extra-articular fractures of the distal phalanges of the fingers

Class A: Type I (longitudinal), Type II (transverse), Type III (comminuted). These fractures are treated with a protective splint, elevating the limb to reduce swelling, and analgesics. A simple palmar splint or a hairpin splint is recommended. Both allow some degree of tissue expansion due to edema.

Subungual hematomas should be drained by drilling out the nail plate using a hot paper clip. These fractures require protective splinting for 3-4 weeks. Comminuted fractures may remain painful for several months.

Class A: Type IV (with displacement). Transverse fractures with angular deformation or width displacement may be difficult to reduce because soft tissue interposition between the fragments is likely. If left uncorrected, this fracture may be complicated by nonunion.

Reposition often perform traction in the dorsal direction for the distal fragment, followed by immobilization with a palmar splint and control radiography to confirm the correctness of the reposition. If unsuccessful, the patient is referred to an orthopedist for surgical treatment.

Class A (open fractures with nail bed rupture). Fractures of the distal phalanges in combination with tears of the nail plate should be considered as open fractures and treated in the operating room. The treatment for these fractures is described below.
1. For anesthesia, a regional block of the wrist or intermetacarpal spaces should be used. Then the brush is processed and covered with sterile material.
2. The nail plate is bluntly separated from the bed (using a spoon or probe) and the matrix.
3. Once the nail plate is removed, the nail bed can be raised and repositioned. The nail bed is then closed with a No. 5-0 Dexon ligature using a minimal number of sutures.
4. Xeroform gauze is placed under the roof of the matrix, separating it from the root. This prevents the development of synechiae, which can lead to deformation of the nail plate.
5. The entire finger is bandaged and splinted for protection. The outer bandage is changed as needed, but the adaptation layer separating the root from the matrix roof must remain in place for 10 days.
6. To confirm the correctness of the reposition, control radiographs are shown. If the bone fragments remain unmatched, osteosynthesis can be performed with a wire.

Complications of extra-articular fractures of the distal phalanges of the fingers

Fractures of the distal phalanges There may be several serious complications associated with it.
1. Open fractures are often complicated by osteomyelitis. Open fractures include fractures associated with a nail bed rupture and fractures with a drained subungual hematoma.
2. Nonunion usually results from interposition of the nail bed between the fragments.
3. With comminuted fractures, as a rule, delayed healing is observed.

A person should contact a specialist at the first manifestations of the disease. At the first stage, treatment of arthrosis of the fingers can completely restore cartilage tissue and return the patient to his previous standard of living.

Rhizarthrosis of the thumb

Arthrosis of the thumb has a second name - rhizarthrosis. It appears quite rarely - in approximately 5% of all cases diagnosed with joint diseases.

In this case, the metacarpal joint is affected at the junction with the wrist bone. At the site of the lesion, deformation of the joint is observed with its protrusion outward.

Diagnostics in a medical institution

Pathology is diagnosed by visual examination by a doctor and subsequent X-ray examination.

In the picture you can see characteristic damage to the joints, as well as determine the stage of development of the disease presented.

Treatment methods

Treatment of the disease involves restoring the previous mobility of the joints by restoring cartilage tissue by any suitable method.

Traditional medicine and effective folk methods are used here.

Traditional medicine

Treatment methods using traditional medicine directly depend on the stage of manifestation of the disease.

1. Drug therapy - first of all, the specialist prescribes non-steroidal anti-inflammatory drugs to eliminate inflammation and pain. After some relief, the patient begins to take chondroprotectors - drugs for restoring cartilage tissue.
2. Physiotherapy – laser therapy, magnetic therapy, paraffin baths, ozokerite baths are used. The sessions are excellent for relieving pain.
3. Exercise therapy - the patient must do simple exercises to regain their previous mobility. Tapping your fingers on the table uses all your finger joints.
4. Massage - light stroking and rubbing - a gentle massage regimen performed by an experienced specialist.
5. Diet – throughout the entire treatment, the patient must adhere to a low-salt diet so that fluid does not remain in the body, and therefore does not provoke swelling and inflammatory processes.
6. Surgical intervention - the patient undergoes removal of growths in the joint parts, and in case of arthrosis of the thumb, the joint is immobilized by installing a fixator - arthrodesis.

Traditional medicine is used in a comprehensive manner in most cases. The patient must follow all the doctor’s instructions in order to quickly eliminate the pain syndrome and return to the previous level of life.

Traditional medicine

Treatment of arthrosis of the fingers with folk remedies is used only to relieve pain, eliminate swelling and inflammation, since they do not stop the process of destruction of cartilage tissue that has begun and do not help restore the balance of microelements.

In particular, the following recipes are used:

1. Mix honey and salt in equal proportions. Mix the mixture thoroughly and apply it to sore joints. Cover your hands with plastic and put on wool mittens. Leave the compress on overnight.
2. It is recommended to make a compress for the night from crushed burdock leaves. They are pre-washed and passed through a meat grinder.

In addition to compresses for the treatment of arthrosis, you can use infusions and other formulations for oral administration. Extract the juice from fresh celery and take 2 teaspoons three times a day.

Be careful, complications are possible!

Pathology with untimely intervention is fraught with serious consequences.

Surgical intervention is the result of complications of the onset of the disease, since the surgical method is used in case of deformation of the joint and adjacent bone.

Therefore, at the first manifestations of aching fingers, you should contact specialists for help.

Prevention methods

As preventive measures, experts recommend eating right - eating more vegetables and fruits, and not overusing salt.

Distribute physical activity correctly so that your fingers do not take all the weight. If you have relatives in your family with similar problems, take preventative measures diligently.

Hand health directly depends on a person’s attitude towards himself. In a busy world, you often don’t find time to visit a doctor in the initial stages of a serious illness.

This kind of negligence can lead to significant problems that will take a long time to resolve.

Phalanges of fingers

The phalanges of the fingers of the human upper limbs consist of three parts - proximal, middle (main) and distal (final). The distal part of the phalanx has a clearly visible nail tuberosity. All fingers of the human hand are formed by three phalanges - nail, middle and main. If we talk about the thumb, it consists of two phalanges. The longest phalanges form the middle fingers, and the thickest ones form the thumbs.

The structure of the phalanges of the fingers

According to anatomists, the phalanges of the fingers of the upper extremities are short tubular bones, which have the shape of a small elongated bone, in the form of a cylinder, with its convex part facing the back of the palms. Almost each end of the phalanges has articular surfaces that take part in the formation of interphalangeal joints. These joints have a block-like shape. They perform two functions - flexion and extension of the fingers. The interphalangeal joints are strengthened by collateral ligaments.

What diseases cause changes in the appearance of the phalanges of the fingers?

Very often, with chronic ailments of the internal organs, the phalanges of the fingers of the upper extremities are modified. They, as a rule, take on the appearance of “drum sticks” (a spherical thickening is observed on the terminal phalanges). As for the nails, they resemble “hour hands”. Similar modifications of the phalanges are observed in the following diseases:

• heart defects;
• cystic fibrosis;
• lung diseases;
• infective endocarditis;
• diffuse goiter;
• Crohn's disease;
• lymphoma;
• cirrhosis;
• esophagitis;
• myeloid leukemia.

The phalanges of the fingers hurt: the main causes

The interphalangeal joints (the smallest joints in the human body) can be affected by diseases that impair their mobility. These diseases are in most cases accompanied by excruciating pain. The main causes of impaired mobility of the interphalangeal joints are:

• deforming osteoarthritis;
• gouty arthritis;
• rheumatoid arthritis;
• psoriatic arthritis.

If these ailments are not treated, then after some time they will lead to severe deformation of the diseased joints, complete disruption of their motor function, as well as atrophy of the hands and muscles of the fingers. The clinical picture of the above ailments is very similar, but their treatment is different. Therefore, medical specialists advise people who have pain in the phalanges of their fingers not to self-medicate, but to contact experienced doctors.

Fracture of the phalanx of the finger

Judging by the reviews of medical specialists, fractures of the phalanges of the fingers, as a rule, occur as a result of a direct blow. If we talk about a fracture of the nail plate of the phalanx, then it is almost always fragmented. Such fractures are accompanied by severe pain in the area of ​​damage to the phalanx, swelling and limited function of the broken finger.

Treatment of fractures of the phalanges of the fingers of the upper extremities without displacement is conservative. In this case, traumatologists apply a plaster cast or an aluminum splint for three weeks, after which they prescribe therapeutic massage, physical education and physiotherapeutic procedures. In case of a displaced fracture, reposition (comparison of bone fragments) is performed under local anesthesia. A plaster cast or metal splint is applied for a month.

What diseases are accompanied by bumps on the phalanges of the fingers?

Bumps on the phalanges of the fingers are manifestations of many diseases, the main ones of which are:

Bumps that appear on the fingers of the upper extremities are accompanied by unbearable pain, which intensifies at night. In addition, there is a characteristic compaction leading to joint immobility, as well as limitation of their flexibility.

As for the treatment of these bumps, it consists of drug therapy, therapeutic and preventive gymnastics, massage, physiotherapeutic procedures and applications.

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Thickening of the terminal phalanges of the fingers or toes

Thickening of the terminal phalanges of the fingers or toes are changes in the area under and around the nails. Thickening of the terminal phalanges of the fingers does not in itself pose any health hazard. However, it is often a symptom of lung disease; however, many other diseases can be the cause. Thickening of the terminal phalanges of the fingers, not associated with any diseases, is inherited in some families.

Symptoms

Softening nails. The nails may seem to “float” - that is, not be firmly attached;

The angle between the nails and the cuticle increases;

The last part of the finger may appear large or protruding. It can also be warm and red;

Curve nails downward, similar to the shape of the round part of an inverted spoon.

Thickenings can develop quickly, often within a few weeks. They can also be easily eliminated once the cause is clear.

Causes of thickening of the terminal phalanges of the fingers or toes

Lung cancer is the most common cause of this disease. Thickenings often develop due to diseases of the heart and lungs, which reduce the amount of oxygen in the blood, such as:

Heart defects that are present at birth (congenital);

Chronic pulmonary infections in humans: bronchiectasis, cystic fibrosis (a systemic hereditary disease caused by a mutation in the gene for the transmembrane regulator of cystic fibrosis and characterized by damage to the exocrine glands, severe dysfunction of the respiratory and gastrointestinal tract; the most common autosomal recessive potentially lethal hereditary disease in white people race), lung abscess;

Infection of the lining of the heart chambers and heart valves (infectious endocarditis), which may be caused by bacteria, fungi, or other infectious agents;

Lung diseases in which the deep tissues of the lungs swell and then form a scar (interstitial lung disease).

Other causes of thickening of the phalanges of the fingers:

Celiac disease (or celiac enteropathy - a multifactorial disease, a digestive disorder caused by damage to the villi of the small intestine by certain foods containing proteins - gluten and related cereal proteins);

Liver cirrhosis and other liver diseases;

Graves' disease (diffuse toxic goiter, Graves' disease - a life-threatening disease of the thyroid gland);

Overactive thyroid gland;

Other types of cancer, including liver and gastrointestinal tract, Hodgkin's lymphoma.

Diagnosis and treatment of thickening of the terminal phalanges of the fingers or toes

The patient should contact his doctor if he notices thickening of the terminal phalanges of the fingers or toes.

Diagnosis is usually based on:

Examination of the lungs and chest.

The doctor's questions to the patient may include the following:

Does he have difficulty breathing;

Do the bulges affect the mobility of his fingers and toes;

When did this thickening first become noticeable;

Is the skin bluish in color at the site of thickening;

What other symptoms accompany this disease?

The following tests can be done:

Arterial blood gas analysis;

CT scan of the chest;

Pulmonary function test.

There is no specific treatment for such thickenings of the terminal phalanges, but treatment of concomitant diseases almost always leads to the elimination of these thickenings.

Thickening of the terminal phalanges of the fingers like “drumsticks”

CLINICAL CASE

A 31-year-old man with a congenital heart defect has thickened the terminal phalanges of his fingers like “drum sticks” since childhood (Fig.). Upon closer examination, thickening of the distal phalanges is visible in the “drumstick” type. He has become accustomed to living with the limitations caused by his congenital heart defect, and his fingers do not bother him at all.

EPIDEMIOLOGY

Prevalence in the general population is unknown:

• 2% of adult patients seeking care in Wales.
• 38% of patients with Crohn's disease and 15% of patients with ulcerative colitis.
• 33% of patients with lung cancer and 11% with COPD.

DRAWING. Thickening of the phalanges like “drumsticks” in a 31-year-old man with congenital heart disease. Noteworthy is the thickening around the proximal edge of the nail.

ETIOLOGY AND PATHOPHYSIOLOGY

The etiology is poorly understood.

Megakaryocytes and platelet accumulations penetrate the histemic bloodstream; from platelets release platelet-derived growth factor, which can cause thickening of the nail bed.

DIAGNOSIS and CLINICAL SIGNS

• Usually painless.
• Changed angle of the nail (Fig.).
• Angle to profile (ABC) > 180°.
• Hyponychial angle (ABD) > 192°.
• Phalanx depth ratio (BE:GF) > I

TYPICAL LOCATION

• Bilateral, all fingers and sometimes toes are involved.
• Rarely unilateral or involving one or more fingers.

DIFFERENTIAL DIAGNOSIS

PRIMARY THICKENING OF THE END PHALANGES ACCORDING TO THE TYPE OF “DRUM STICKS”

• Pachydermoperiostosis.
• Familial thickening of the terminal phalanges of the “drumstick” type.
• Hypertrophic osteoarthropathy.

SECONDARY THICKENING OF THE TERMINAL PHALANGES ACCORDING TO THE TYPE OF “DRUMP STICKS”

Secondary thickening of the terminal phalanges in the form of “drumsticks” can be caused by many diseases, including the following:

• Gastrointestinal diseases: inflammatory bowel disease, liver cirrhosis and celiac disease.
• Lung diseases: malignant neoplasms, asbestosis, ischemic obstructive pulmonary diseases, cystic fibrosis.
• Heart disease: congenital heart defects, endocarditis, atrioventricular malformations or fistulas.

TREATMENT

DRAWING. Thickening of the phalanges like “drumsticks” close-up.

DRAWING. Thickening of the phalanges in the form of “drumsticks” in a 55-year-old man suffering from COPD. Changed angle in profile (ABC); the depth of the distal phalanx (BE) is greater than the interphalangeal depth (GF)

Drumstick symptom

The symptom of drumsticks (Hippocratic fingers or drum fingers) is a painless flask-shaped thickening of the terminal phalanges of the fingers and toes that does not affect the bone tissue, which is observed in chronic diseases of the heart, liver or lungs. Changes in the thickness of the soft tissues are accompanied by an increase in the angle between the posterior nail fold and the nail plate to 180° or more, and the nail plates are deformed, resembling watch glasses.

General information

The first mention of fingers resembling drumsticks is found in Hippocrates in the description of empyema (an accumulation of pus in a body cavity or hollow organ), therefore such deformation of the fingers is often called Hippocratic fingers.

In the 19th century The German doctor Eugene Bamberger and the Frenchman Pierre Marie described hypertrophic osteoarthropathy (secondary damage to the long bones), in which “drumstick” fingers are often observed. By 1918, doctors considered these pathological conditions to be a sign of chronic infections.

Forms

In most cases, drumstick fingers are observed on the hands and feet simultaneously, but isolated changes also occur (only the fingers or only the toes are affected). Selective changes are characteristic of cyanotic forms of congenital heart defects, in which only the upper or lower half of the body is supplied with oxygenated blood.

Based on the nature of the pathological changes, fingers are classified as “drumsticks”:

• Resembling a parrot's beak. The deformity is associated primarily with the growth of the proximal part of the distal phalanx.
• Reminiscent of watch glasses. The deformity is associated with tissue growing at the base of the nail.
• True drumsticks. Tissue growth occurs along the entire circumference of the phalanx.

Reasons for development

The causes of the drumstick symptom may be:

• Lung diseases. The symptom manifests itself in bronchogenic lung cancer, chronic suppurative lung diseases, bronchiectasis (irreversible local dilation of the bronchi), lung abscess, pleural empyema, cystic fibrosis and fibrous alveolitis.
• Cardiovascular diseases, which include infective endocarditis (heart valves and endothelium are affected by various pathogens) and congenital heart defects. The symptom is accompanied by the blue type of congenital heart defects, in which a bluish tint to the patient’s skin is observed (includes tetralogy of Fallot, transposition of the great vessels and pulmonary atresia).
• Gastrointestinal diseases. The symptom of drumsticks is observed in cirrhosis, ulcerative colitis, Crohn's disease, enteropathy (celiac disease).

Drumstick fingers can be a symptom of other types of diseases. This group includes:

• cystic fibrosis is an autosomal recessive disease that is caused by a CFTR mutation and manifests itself with severe respiratory impairment;
• Graves' disease (diffuse toxic goiter, Graves' disease), which is an autoimmune disease;
• trichocephalosis is a helminthiasis that develops when the gastrointestinal tract is affected by whipworms.

Fingers resembling drumsticks are considered the main manifestation of Marie-Bamberger syndrome (hypertrophic osteoarthropathy), which is a systemic lesion of long bones and in 90% of all cases is caused by bronchogenic cancer.

The cause of unilateral damage to the fingers may be:

• Pancoast tumor (occurs when cancer cells damage the first (apical) segment of the lung);
• lymphangitis (inflammation of the lymphatic vessels);
• application of an arteriovenous fistula to purify the blood by hemodialysis (used for renal failure).

There are other, little-studied and rare causes of the development of the symptom - taking losartan and other angiotensin II receptor blockers, etc.

Pathogenesis

The mechanisms of development of drumstick syndrome have not yet been fully established, but it is known that deformation of the fingers occurs as a result of impaired blood microcirculation and the local tissue hypoxia that develops as a result.

Chronic hypoxia causes dilation of blood vessels located in the distal phalanges of the fingers. There is also increased blood flow to these areas of the body. It is believed that blood flow is increased by the opening of arteriovenous anastomoses (blood vessels that connect arteries to veins), which occurs as a result of the action of an unidentified endogenous (internal) vasodilator.

The result of impaired humoral regulation is the proliferation of connective tissue lying between the bone and the nail plate. Moreover, the more significant the hypoxemia and endogenous intoxication, the more severe the modifications of the terminal phalanges of the fingers and toes will be.

However, hypoxemia is not typical for chronic inflammatory bowel diseases. At the same time, changes in the fingers like “drumsticks” are not only observed in Crohn’s disease, but also often precede intestinal manifestations of the disease.

Symptoms

The symptom of drumsticks does not cause pain, so initially it develops almost unnoticed by the patient.

Signs of the symptom are:

• Thickening of the soft tissues on the terminal phalanges of the fingers, in which the normal angle between the digital fold and the base of the finger disappears (Lovibond angle). Usually the changes are more noticeable on the fingers.
• Disappearance of the gap that normally forms between the nails if the nails of the right and left hands are placed together (Shamroth’s symptom).
• Increasing curvature of the nail bed in all directions.
• Increased looseness of tissue at the base of the nail.
• Special elasticity of the nail plate during palpation (balling the nail).

When the tissue at the base of the nail grows, the nails become like watch glasses.

Front view Side view

Signs of the underlying disease are also observed.

In many cases (bronchiectasis, cystic fibrosis, lung abscess, chronic empyema), the symptom of drumsticks is accompanied by hypertrophic osteoarthropathy, which is characterized by:

• aching pain in the bones (in some cases severe) and painful sensations on palpation;
• the presence of shiny and often thickened skin that is warm to the touch in the pretibial area;
• symmetrical arthritis-like changes in the wrist, elbow, ankle and knee joints (one or more joints may be affected);
• coarsening of the subcutaneous tissues in the area of ​​the distal arms, legs, and sometimes the face;
• neurovascular disorders in the hands and feet (paresthesia, chronic erythema, increased sweating).

The time for symptom development depends on the type of disease that provoked the symptom. Thus, a lung abscess leads to the disappearance of the Lovibond angle and the balloting of the nail 10 days after aspiration (foreign substances entering the lungs).

Diagnostics

If the symptom of drumsticks occurs in isolation from Marie–Bamberger syndrome, the diagnosis is made based on the following criteria:

• There is no Lovibond angle, which can be easily established by applying a regular pencil to the nail (along the finger). The absence of a gap between the nail and the pencil indicates the presence of the drumstick symptom. The disappearance of the Lovibond angle can also be determined thanks to the Shamroth symptom.
• Elasticity of the nail upon palpation. To check for a runaway nail, press on the skin just above the nail and then release it. If the nail, when pressed, sinks into the soft tissue, and after the skin is released, springs back, the presence of the drumstick symptom is assumed (a similar effect is observed in older people and in the absence of this symptom).
• Increased ratio between the thickness of the distal phalanx at the cuticle and the thickness of the interphalangeal joint. Normally, this ratio averages 0.895. In the presence of the drumstick symptom, this ratio is equal to or greater than 1.0. This ratio is considered a highly specific indicator of this symptom (in 85% of children with cystic fibrosis, this ratio exceeds 1.0, and in children suffering from chronic bronchial asthma, this ratio is exceeded in only 5% of cases).

If a combination of the drumstick symptom with hypertrophic osteoarthropathy is suspected, bone radiography or scintigraphy is performed.

Diagnosis also includes studies to identify the cause of the symptom. To do this:

• study anamnesis;
• do an ultrasound of the lungs, liver and heart;
• a chest x-ray is performed;
• CT and ECG are prescribed;
• examine the functions of external respiration;
• determine the gas composition of the blood;
• do a general blood and urine test.

Treatment

Treatment for drumstick-type finger deformities involves treating the underlying disease. The patient may be prescribed antibiotic therapy, anti-inflammatory therapy, diet, immunomodulatory drugs, etc.

Forecast

The prognosis depends on the cause of the symptom - if the cause is eliminated (cure or stable remission), symptoms may regress and the fingers will return to normal.

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As automation and safety advances, finger avulsions are becoming less common. According to our data, they amount to 2.6%. Severations of phalanges and fingers in most cases occur at work when the hand gets caught in moving parts of mechanisms, less often - from transport or household injuries. Avulsions most often affect the distal phalanges of the fingers; The more proximal the part of the hand is located, the less common is its primary loss.

The primary loss of fingers and parts of the hand refers to avulsions, when damage causes one or another part to be separated from the hand (Fig. 126).

Plumber M., 44 years old, while drunk, got his hand under the drive belt. At the trauma center, primary treatment was performed: cross-sectional anesthesia in the middle third of the forearm with 0.25% novocaine 100 ml, hemostatic bandage at the level of anesthesia.

Rice. 126. Detachment of fingers II-III-IV-V at the level of the base of the proximal phalanges.
a - view of the hand after injury - severed fingers are brought in a bandage (drawing from life); b - diagram of the radiograph.

Cleaning of the skin, primary treatment of wounds of the stumps of II-III-IV and V fingers, removal of bone fragments, alignment of bone stumps and closure of circular wounds with grafts according to Krasovitov and Yanovich-Chainsky. Wound healing with complete engraftment of grafts and good stump formation. Six months later, the victim was offered reconstructive intervention, which he refused, citing the fact that he could cope with the work of a plumber. The short stumps and proximal phalanges are mobile and painless.

Sometimes victims bring to the surgeon the torn parts in a bandage, but more often they present with an open wound and a tissue flaw.

Recognizing separations, of course, is not difficult. Wounds with incomplete cutting, when there is a connection between the damaged part and the proximal part of the hand, are not avulsions, but complicated wounds or open fractures.

The principles and methods of treating the stump are the same as those discussed in the wounds section, but the rules for preserving every centimeter of tissue must be strictly observed. The surgeon faces the following questions: is it advisable to reattach the torn phalanges, is it possible to use soft tissue from the torn parts, how to treat the stump in case of avulsions with limited and extensive tissue damage, destruction of the arm, what are the features of subsequent treatment?

Almost every surgeon working in a trauma center tries to reattach a torn part or finger, but so far in the case of a true avulsion this is only possible in the hands of specialists. More often, there are reports of cases of complete or partial success of reimplantation of fingers and hands, which retained the connection with the limb in the form of a narrow skin-vascular bridge (subtotal avulsions).

P. D. Topalov (1967), who developed a special surgical technique and a microclimate chamber, reports the reimplantation of 42 severed fingers in 32 victims. In 30 patients, complete engraftment was achieved, in 9 - partial (with necrosis of the distal phalanges), complete necrosis - in 3.

Reimplantation of a hand amputated at the level of the wrist with modern advances in microsurgery is considered natural. Cobbett (1967) considers reimplantation of fingers severed proximally to the diaphysis of the middle phalanx to be indicated in all cases where the finger is not crushed. At present, the indications, necessary conditions and instruments, the duration of microsurgical reconstructive operations on the fingers (4-6 hours) have already been clarified, a technique for suture of the digital arteries, veins and nerves and details of the postoperative period have been developed. In specialized departments of hand surgery in the coming years, reimplantation of the hand and fingers will be the final stage of primary wound treatment (B.V. Petrovsky, V.S. Krylov, 1976).

Therefore, if the rejected part of the hand is preserved, then the victim should be sent for reimplantation to a medical institution where there are conditions and a specialist involved in hand microsurgery. This approach is especially important for thumb avulsions and multiple traumatic finger amputations. All viable tissues are used here, various methods of transplantation, and movement of adjacent fingers are used, taking into account their significance for the function of the hand. The success of primary restorative treatment of wounds with avulsions of parts, entire fingers and sections of the hand depends on the atraumaticity, asepsis of the operation, the thoroughness of restoration of anatomical relationships: osteosynthesis, vascular suture of arteries, veins and nerves of the finger, skillful use of anticoagulants and antibiotics. The further process of rehabilitation of the victim is very important.

Torn skin is successfully used in processing using the Krasovitov method. Hanging, exfoliated skin is cut off, tubular flaps are dissected and turned into flat ones. The flap is cleaned of contamination, washed with a hypertonic solution, and lubricated with iodine tincture both from the wound and from the outer epidermal side. Having placed the flap with the wound surface up on a hard table covered with a smooth sterile napkin or sheet, or on a dermatome, the surgeon and assistant stretch it and use a sharp abdominal scalpel to remove fat from it to the dermis. It takes on the appearance of a “full-thickness flap.” Then it is washed again in a warm saline solution and wiped with a napkin soaked in a saline solution mixed with alcohol. Several holes are pierced with a scalpel for lymph drainage, and then the reimplant is sewn to the defect with frequent nylon sutures. The rejected skin flaps are used after 24-48 hours.

In case of extensive injuries, when there are simultaneous avulsions of several fingers or parts of the hand and there are insufficient local resources to cover the stump wound, it is necessary to close the skin defects by transplanting full-thickness grafts or other methods, observing the principles of sparing treatment.

The advantage of replacing defects in the stump with a graft and other types of transplantation before primary amputation along the length is that thanks to the transplantation, the distal parts are preserved from truncation, which are subsequently well mastered by patients or are suitable for reconstructive operations and prosthetics. In this case, the wound heals almost in the same time as after truncation (V.K. Kalnberz, 1975).

Damage to the nail and fingertip. The increased interest in modern literature in injuries accompanied by damage to the nail, loss of the tip of the fingers, indicates the recognition of the importance of the nail and the “tip of the finger” in differentiated types of labor.

In this regard, the tactics for the initial treatment of a wound complicated by damage to the nail are being revised. The torn nail plates are not thrown away, but after treatment they are placed in a bed and sewn on (Masse, 1967). In their absence, specially prepared homografts of nail plates are used. For 3 weeks they perform a protective and fixing role, and with the beginning of the growth of a new nail, they disappear. When treating open fractures, fragments of the phalanx associated with the nail bed are preserved, the nail bed is restored, the edges of its wound are compared and an atraumatic suture is applied to ensure the growth of the nail plate (Fig. 127).

Many methods are proposed for “full” replacement of a defect in the loss of a fingertip. The method of choice for guillotine amputation is considered to be moving the flap from the palm side of the finger. In this case, the pedicle of the flap must contain the palmar digital nerve to preserve sensitivity and stereognosis. This method is preferred to grafting from adjacent fingers and layer-by-layer grafting. The Tranguilli-Leali method has become more widespread (P. A. Gubanova, 1972). Now there is a unanimous opinion among surgeons that in case of traumatic avulsions at the level of the distal phalanx, when reimplantation is impossible, reliable coverage of the defect is necessary in one way or another (Fig. 128). When taking flaps from the palm and adjacent fingers, it must be taken into account that this will create a new defect and sometimes require long-term adaptation of the patient to the additional scar.

In the last decade, the issue of complete restoration of the fingertip has grown into a problem discussed in periodicals, at symposia and congresses of surgeons. As a result of the discussion, a classification of the types of primary losses of the fingertip is recommended (R. A. Gubanova, 1972; S. Ya. Doletsky et al., 1976). Michon et al. (1970) and others, the basis for the classification and recommendations for replacing a defect is the level of amputation, taking into account damage to the bone, nail matrix and tendon attachments (Fig. 129).

Now special attention is paid to the conservative method of treating the stump using a long-term bandage, under which spontaneous healing occurs at levels I-II. Levels III and IV amputation require radical excision of the nail matrix and closure of the stump by plastic surgery (E. V. Usoltseva, 1961; S. Ya. Doletsky et al., 1976).

Postoperative complex treatment for finger avulsions is early, systematic rehabilitation training of the victim in self-care and work processes. It is carried out in various techniques, but all of them are aimed at developing and strengthening functional skills so that the victim masters the stumps and reimplants of the fingers. This is facilitated by: painlessness of the operation, bed rest, elevated position of the arm, painkillers and sleeping pills, contact of the patient with the surgeon and the methodologist of therapeutic exercises, familiarization of the victim with the prognosis and his role in the rehabilitation process.

Rice. 127. Scheme of fixation of the nail plate.

Rice. 128. Various types of plastic surgery for avulsions and guillotine amputations of the fingertips.
a - movement of the skin on the finger; b - Tranquili-Leali method; c - flap on the feeding pedicle from the adjacent finger; g - from the palm; E - microstem according to Khitrov.

Rice. 129. Four levels of traumatic amputation of the distal phalanx.
Defect: 1 - crumb; 2 - at the level of the tuberosity of the distal phalanx; 3 - at the level of the diaphysis of the distal phalanx; 4 - at the level of the base of the distal phalanx with damage to the nail matrix and tendons.

The course and outcomes after primary loss of fingers and hands are similar to open fractures, but the duration of treatment is longer. Multiple losses of the phalanges have a particularly difficult impact on hand function; the victims find it difficult to adapt to work until their stumps are strong and painful, and this must be taken into account.

Amputation and disarticulation of phalanges, fingers, hands. The need to amputate the phalanges, fingers, parts and the entire hand may arise during the treatment of wounds and open fractures, in the process of treating not only injuries, but also diseases of the hand, and sometimes in the period long after injury or illness, when the hand becomes a hindrance and threatens health . Depending on the time, the purpose, indications and technique of amputation are different.

Amputation and disarticulation along the finger during the primary treatment of wounds in peacetime are indicated only when the finger is crushed, i.e., with complete disruption of blood circulation, innervation, damage to the tendons and skeleton - this is amputation for primary indications.

Secondary indications for amputation of the phalanges of the fingers and hand are dictated by complications that arise during the wound process, threatening the life of the victim or the preservation of the organ, as well as consequences that reduce the functional suitability of the hand.

The question of the level of amputation of phalanges, fingers and hands currently does not have the same importance as at the end of the last century and in the thirties of our century. This is explained by the fact that reconstructive operations now use those parts of the phalanges that were previously considered to have no functional significance. Currently, surgeons amputate the phalanges, fingers and hand “as low as possible” (N.I. Pirogov).

The question of the advantage of amputation over disarticulation is decided by surgeons in accordance with the level and severity of tissue damage. Of particular importance is the preservation of the attachment sites of the flexor and extensor tendons of the fingers, the bases of the proximal phalanges, as they support the surviving fingers and prevent them from deviating to the sides, ensuring stability and the exact direction of their movements.

When disarticulation of the II and V fingers, some surgeons recommend immediately removing the head of the metacarpal bone, creating a narrow hand. However, the question of the advantage of a “narrow” brush must be approached with caution, since cosmetic considerations are not always acceptable. They are not a reason to truncate the metacarpal bone if it is possible to amputate more distally. When filing the head of the metacarpal bone, the strength of the hand is significantly reduced and subsequent reconstructive operations are difficult. Therefore, amputation of fingers at the level of the diaphysis of the metacarpal bones during primary treatment of the wound is permissible only if not only the fingers, but also the metacarpophalangeal joints are crushed. A special approach in this matter requires the thumb, which provides 40% of the functionality of the hand. Even a short stump of the thumb is useful if the rest of the thumb can reach it and a grip is possible. The scalped thumb is covered with a Filatov stem, and the short stump is lengthened using the distraction method (N.M. Vodyanov, 1974; V.V. Azolov, 1976, etc.).

With multiple wounds, as already indicated, every millimeter of tissue should be preserved, since at the first moment it is difficult to predict which fingers and parts of the hand will be viable and functionally suitable.

19 year old vocational school student E. I hit my hand in a stone crusher. An ambulance was taken to the hospital, where an open fracture of the distal and middle phalanges of the II and V fingers, a fracture of the distal phalanx of the III and middle phalanx of the IV finger was established. Under general anesthesia, primary treatment was performed with the separation of the II and V fingers in the proximal interphalangeal joint and the application of blind sutures to the stumps. The wound of the fourth finger is treated, the fragments are compared and a blind suture is applied and traction is applied to the soft tissue of the distal phalanx using a Beler splint. The patient was sent to the clinic for further treatment. There were no acute pains, but on the seventh day an infection developed, the sutures on the stumps of the II and V fingers separated, the sawdust of the phalanges was exposed, and necrosis of the IV finger became apparent (Fig. 130, a, see inset). Further treatment was lengthy: the second finger was reamputated twice, the fourth and fifth fingers were reamputated once, and the phlegmon of the midpalmar space was opened. The victim was disabled for 97 days and recognized as a group II disabled person.

U machine operator Ts., 44 years old, the surgeon preserved the partially severed crushed phalanges of the I-I fingers of the right hand. The outcome is favorable (Fig. 130, b, c).

Finger amputation technique

Finger and hand truncation operations do not present any particular difficulties, but they are often atypical and individual for each victim. However, the basic rules for finger amputation must be followed in any setting. Briefly, they boil down to the following provisions.

Thorough disinfection of the skin of the hand and forearm. Complete anesthesia and bleeding. Skin flaps with subcutaneous tissue are cut out longer than the diameter of the finger on any side of it - palmar, dorsal or lateral, where there is healthy skin. The soft tissues are cut down to the bone with a cutting motion at a selected level, retracted proximally with a hand retractor, and carefully protected while sawing through the bone.

The bone is sawed perpendicular to the axis of the finger with a diamond disc included in a drill, or with an electric drill (this is the most atraumatic method that produces an even file), if there is no disc, with a Gigli saw or a thin hacksaw. The sawdust is smoothed with a fissure and cleaned with a rasp or file. Ligatures are applied to the palmar digital arteries. The finger flexor and extensor tendons are inspected; if they are crushed or torn, they are cut off at the level of the healthy part and sewn to the soft tissue or periosteum. The nerves of the fingers are examined; if they are visible on the surface, they stand out slightly and are cut off with a safety razor blade 1.5-2 mm proximal to the bone sawdust. When the soft tissues are cut correctly, the nerves in the wound are not visible. Bone chips from the bone sawdust are carefully removed with a stream of hot saline solution or rivanol or with a damp ball. Stump drainage is necessary in cases where the surgeon is not confident in hemostasis and aseptic healing. Drainage is carried out with threads of fishing line, silk or thin rubber strips and is brought to the rear through a special incision. It is not recommended to place it on the palm or side of the finger. Before suturing, excess tissue is cut off, the flaps are carefully adjusted and strengthened with rare sutures or pinned with thin short needles (if there are no contraindications to closing the wound). Stumps can be covered in a variety of ways depending on the condition of the tissue.

For example, in patient B., when fingers I-II and III were torn off at the level of the proximal phalanges, the more even stump of the first finger was closed after treatment with a graft using the Larin method. On the stump of the second finger, the palmar and dorsal flaps turned out to be sufficient and were freely brought together over the sawdust and stitched. On the third finger, there was not enough soft tissue to cover the defect, and the sawdust was covered with skin grafts taken from the severed finger.

After the operation, the stump is covered with a tiled-like applied pressure bandage. For extensive damage, a plaster splint with pad or splint is applied. After a day, without completely removing the bandage, the drainage is removed. Sutures after amputation are removed later than usual - on the 10-12th day. Therapeutic exercises begin when the pain subsides and the danger of infection has passed.

Exarticulation of the fingers is carried out on the basis of the same provisions. Experience has shown that its success largely depends on how carefully the articular capsule and ligaments are excised; the cartilaginous surface, if not damaged, is preserved. When amputating a finger at the level of the diaphysis of the metacarpal bones, a longitudinal incision parallel to the axis of the finger is most often used, less often - rocket-shaped and wedge-shaped, depending on where there is healthy skin on the finger; The surgical technique is not standard.

When amputation is performed at the level of the metacarpal bone, the metacarpal joint, or at the base of the finger, especially the first, when there is no flap to cover the stump, tissue is moved, a free skin graft or a flaw is replaced with a Filatov stem.

Amputation or disarticulation of fingers during the period of purulent tissue melting is inappropriate, as it leads to a high percentage of complications, reamputation, prolongs the treatment period and aggravates the outcome.

The gentle tactics adopted by surgeons of the Soviet Union both in peacetime and in wartime are fully justified, since with timely surgical treatment of the wound, antibiotic therapy, osteosynthesis and skin plastic surgery, those fingers for which there are relative indications for truncation are preserved. Subsequent complex treatment, reconstructive interventions and labor training for victims contribute to the restoration of lost functions and adaptation of preserved functions. Saved fingers turn out to be active.

In modern literature, much attention is paid to the issue of postoperative pain in the stump. Linking the origin of these pains with the development of neuroma on the nerve stump, to prevent it, surgeons used various methods of treating the end of the truncated nerve - from alcoholization, freezing with chlorethyl to cauterization.

However, the cause of postoperative pain is not always the presence of a neuroma developing at the end of the truncated nerve, as was generally believed. Pain is often caused by irritation of axons by inflammatory infiltrate or compression by scar tissue and concomitant vasomotor disorders. Consequently, the most effective measure aimed at preventing these complications is to prevent the development of inflammatory phenomena in the wound. Therefore, most modern surgeons refuse any chemical or physical effects on the nerve stump during amputation. The average number of days of disability for primary losses and amputation of the phalanges ranges from 28.5 to 64.5.

E.V.Usoltseva, K.I.Mashkara
Surgery for diseases and injuries of the hand