clubbed fingers (toes)
Introduction
Introduction The soft tissue at the end of the toe is thickened like a drum, and has an arched bulge. The longitudinal ridges and transverse ridges are highly curved, and the surface is glassy, called an acropocy.clubbing finger. Also known as the faded finger. The angle between the side nail and the nail skin of the healthy person's finger is 160 degrees. With the occurrence of the forest finger, the angle can be gradually increased to 180 degrees or more. Pressing the root of the nail can have a noticeable elasticity and tenderness. The finger-like fingers appearing in different diseases have different fingertip colors. The forest finger of the congenital heart disease of the hair group, the finger is often purple and black, the nail arc is reddish brown, the capillary of the nail bed is increased, and the blood flow at the finger end is increased. In patients with lung disease, the fingertips of the forest finger are dry and not smooth, yellowish white, and the blood vessel proliferation is not significant.
Cause
Cause
Except for a few congenital familial material fingers (toes), most of them are congenital heart disease or acquired heart, lung, digestive tract disease and some osteoarthrosis and poisoning. It refers to providing reliable clues and evidence for the diagnosis of clinical diseases. The lemon-like finger (toe) can be found in many diseases, and the cause is common in:
(a) hair clip type congenital heart disease
Such as tetralogy of Fallot, complete pulmonary venous malformation, pulmonary venous tumor, subacute bacterial endocarditis, infectious myocarditis, rheumatic heart disease, chronic congestive heart failure, pericarditis.
(two) respiratory diseases
Such as bronchial lung cancer, pleural mesothelioma, bronchiectasis. Chronic lung abscess, empyema, emphysema with tuberculosis, intestinal tuberculosis, Hammn-Rich syndrome, thoracic tumor and so on.
(3) Digestive diseases
Such as malabsorption syndrome, Crohn's disease (crohn disease, crohn-Les niowskg syndrome) chronic ulcerative colitis, intestinal tuberculosis, chronic bacterial dysentery, amoebic dysentery, mites infection, colonic multiple polyps, pyloric cancer Wait.
(4) Others
Can be seen in idiopathic osteoarthrosis (Touraine-Solentegole disease), syringomyelia, congenital syphilis, some poisoning such as arsenic, phosphorus, alcohol, sputum and so on.
Examine
an examination
Related inspection
Pulmonary diffusion function measurement (DL) lung compliance (C)
Physical examination
A comprehensive and detailed physical examination is an important means of discovering abnormal signs of patients. The discovery and determination of the sign of the toe (toe) can be done with the naked eye, which is very intuitive and relatively easy. The presence of a finger (toe) at the end of the finger can be observed by the clinician's naked eye. The clinician conducts a physical examination of the patient, and further collects data and finds positive signs to provide a basis for the diagnosis of the disease.
The physical examination should be carried out according to the main complaint. If the patient is found to have a material finger (the toe should focus on the characteristic signs of the disease-like toe), and the characteristic signs are in the comprehensive physical examination. Found.
Physical examination, first of all, should understand the patient's temperature, pulse, breathing, blood pressure. Then systematically check, including the patient's general condition, the content of the mental state, nutritional status, sleep and eating conditions, and the degree of self-care in daily life. Skin and subcutaneous mucosa should pay attention to color, presence or absence of blemishes, bleeding spots, spider mites, ulceration, surgical scars, etc. Whether the superficial lymph nodes have abnormal swelling, hardness, or abnormal activity. Head, pay attention to check whether the facial features are correct, the hair distribution, whether there is abnormal shedding, sparse. Eyes, ears, nose, tonsils with or without secretions. Whether the chest is normal, whether there is a barrel chest, chicken breast, sternum with or without bulging, with or without tenderness. Whether the lungs have normal breathing sounds, whether there are abnormal breathing, whether the mediastinum is widened, and whether the sternum is tender or not.
Cardiac examination is an important part of chest examination. Pay attention to whether the heart is normal, whether the heart rate is fast, whether the heart rhythm is regular, whether the heart valves have murmurs, and whether the heart and blood vessels have abnormal passages. Abdominal examination, including whether the size of the liver is normal, the hardness of the liver, whether the surface of the liver is smooth, whether the liver area is tender, whether there is abdominal varicose veins in the abdomen, whether there is tenderness, pay special attention to the right lower abdomen. Because the diseases associated with the clubbing (toe) occur more often. At the same time, the physical examination should also touch the kidney area, and found abnormalities in the kidneys, as there have been reports of clubbing (toe) due to chronic pyelonephritis. Spinal and neurological examinations can be performed routinely. Limb examination is the easiest and most intuitive way to find the clubbing (toe). It can be found in the presence of clubbing (toe), especially attention.
Diagnosis
Differential diagnosis
The diagnosis should be differentiated from the following symptoms:
1. Giant finger (toe) is a congenital malformation characterized by an increase in the volume of the fingers or toes. The incidence in congenital malformations of the extremities is very low, about 0.9%. Since the lesion is mostly located on one side of the finger, in addition to seeing the entire finger being large, the common side is overgrown and the finger is curved to the side to be skewed laterally. The lesion is characterized by the proliferation of bone and fat. The giant finger not only affects the shape of the hand, but also affects the function. If the enlarged lesion is located in the carpal tunnel, there will be symptoms of nerve compression.
2. Spoon finger (toe): The clinical manifestations of Plummer-Vinson syndrome. The main clinical manifestations are dysphagia, pharyngeal foreign body sensation, intermittent dysphagia, no pain, and often develop into persistence. More common iron deficiency anemia performance, such as loss of appetite, fatigue, palpitations, pale, spoon finger (toe) and hair loss. Also often accompanied by angular cheilitis, glossitis, smooth tongue, atrophy, nipple disappeared. In most patients, X-ray and esophagoscopy revealed a diaphragm-type mucosal diaphragm in the lower part of the throat and upper part of the esophagus. Almost all of the laboratory tests have iron deficiency anemia, serum iron concentration is significantly reduced, and some have pernicious anemia.
3. Playing the piano finger (toe) sign: clinical manifestations of tardive dyskinesia, mainly showing involuntary movements of rhythmic stereotypic duplication, early manifestation of tongue tremor or salivation, the oral movement of the elderly is characteristic, and the limb involvement of young patients is common. Children's oral and facial symptoms are more prominent, the lower muscles are most often involved, showing mouth-tongue-buster triad (BLM syndrome) or buccal, tongue, chewing syndrome, showing uncontrollable movements of the lips and tongue, such as involuntary Continuously chewing, sucking, turning tongue, tongue, mouth and drumsticks, jaw and neck, sometimes the tongue involuntarily suddenly protrudes out of the mouth, called the fly-catcher tongue, which occurs in severe cases. Unclear articulation and dysphagia. The trunk muscles are affected by the body shaking, the distal part of the limb is affected by the performance of the piano finger (toe) sign, the proximal part of the limb is rarely affected, a few show dance-like movements, no purpose flapping, two legs constantly jumping, the hands and feet are moving, the trunk is twisted Sexual sports and quirky postures. Occasionally showed gastrointestinal type, stomach discomfort, nausea and vomiting occurred after sudden withdrawal. When the mood is tense and excited, the symptoms worsen and disappear when you sleep. Some patients coexist with delayed sedation, delayed dystonia, and drug-induced Parkinson syndrome. Symptoms are easily concealed and exposed when drugs are reduced or discontinued.
4. Spider finger (toe): more common in Marfan syndrome, mainly with slender limbs, spider fingers (toe), arms extended beyond the length of the body, hands hanging over the knees, the upper body is longer than the lower body. Long head deformity, narrow face, high bow, large ears and low position. Less subcutaneous fat, muscles are underdeveloped, wrinkles on the chest, abdomen, and arms. Low muscle tone, showing a weak body. The ligaments, tendons, and joint capsules are elongated, relaxed, and the joints are overstretched. Sometimes see the funnel chest, chicken breast, kyphosis, scoliosis, spina bifida and so on.
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