Finger deformity

Definition

Finger deformity develops in traumatic injuries, degenerative and inflammatory diseases, malformations, and hereditary pathologies. It is caused by changes in the length, thickness, and configuration of the phalanges or their location relative to each other, violation of the shape of the joints, fibrous growths, and swelling of soft tissues. Determination of the cause of pathology is carried out based on interview data, physical examination, radiography, CT, MRI, and laboratory tests. Before the diagnosis is made, sometimes the use of analgesics and anti-inflammatory drugs is allowed.

Causes

Traumatic injuries

Finger deformities are caused by the following injuries:

• Contusion. The finger is swollen, moderate pain on palpation, and movement is determined. All symptoms gradually disappear after 1-2 weeks.
• Fracture. The change in shape is due to swelling or displacement of the fragments. In the latter case, shortening and axial curvature are detected. Pain is intense, and the function of the hand is sharply reduced, sometimes revealing crepitation and pathological mobility.
• Dislocation. The finger is sharply deformed in the joint area; movement is impossible. There is a pronounced pain syndrome.
• Subcutaneous tendon rupture occurs when the end of the finger (more often the index finger) strikes a hard surface. The distal phalanx is bent, the finger takes the form of a hook, and active extension is impossible.

Arthritis

Deformity of the fingers of the hands in the early stages occurs due to edema in the subsequent stages – due to destruction, erosion, and fibrosis of the articular ends of the bones and cartilage tissue. The features of the clinical picture are determined by the type of arthritis:

• Rheumatoid. The metacarpophalangeal joints of the 2nd and 3rd fingers are most often affected; multiple arthritis is possible. The lesion is symmetrical. The involvement of the distal joints is uncharacteristic.
• Psoriatic. The lesion is asymmetrical. All joints of the finger are involved in the inflammatory process, which, due to edema, resembles a sausage. The skin over the joints is purplish-blue.
• Gout. Women’s hands’ joints are more often inflamed. Oligo- or polyarthritis is possible. The course is attack-like. Intense pain is combined with swelling, hyperemia, and an increase in local temperature.
• Juvenile rheumatoid. Diagnosed in children younger than 16 years of age. The localization of inflammation is the same as in regular rheumatoid arthritis.

Developmental anomalies

Congenital finger malformations may occur in isolation, combined with other stigmas of embryogenesis, or observed as part of syndromic pathologies:

• Ectrodactyly. One or more fingers are underdeveloped. The hand often resembles a crab’s claw because of the medial cleft.
• Syndactyly. There is a complete or partial fusion of the fingers with each other. The shape and size of the fingers may be preserved (simple form of the disease) or changed (complex syndactyly).
• Brachydactyly. One or more phalanges are shortened. May be combined with syndactyly, rotation of the phalanges around the axis, change in the shape of the nail plate, underdevelopment of the metacarpal bones.
• Clinodactyly. Affects the little fingers of the hands, observed in catcall, Russell-Silver, and Down syndromes.
• Polydactyly. There are additional full, bifurcated, or rudimentary fingers on the hand.
• Arachnodactyly. The fingers are long, thin, and characteristically curved. The deformity is combined with other skeletal changes and is usually part of syndromic pathologies: homocystinuria, Marfan syndromes, lens ectopia, aortic dissection, and dilatation.

Hereditary syndromes

Finger deformities are seen in a large number of diseases due to random mutations, aneuploidies, and genetic anomalies:

• Progeria. Deformities are caused by early aging of the body, development of osteoarthritis.
• Mucopolysaccharidosis. The first symptom of the disease is acquired flexion contractures.

Other reasons

Other possible causes of the symptom include the following conditions:

• Panaritium. There is significant swelling, in deep forms the outcome is often gross deformities due to bone defects, joint damage.
• Syringomyelia. Fingers thicken, and the skin becomes dry and rough.
• Chondroma. Often occurs in the phalangeal area. It grows slowly over several years.
• Rickets. Thickening of the interphalangeal joints (“strings of pearls”).
• Paresis, paralysis. The fingers of the hands are deformed due to innervation disorders, atrophy, and predominance of the pull of some muscle groups over others.
• Neoplastic processes: peripheral lung cancer, esophageal cancer, thyroid cancer, lymphogranulomatosis, mediastinal sarcoma, pleural mesothelioma, metastases to the mediastinum.
• Diseases of the lungs and pleura: pleural empyema, lung abscess, chronic pneumonia, bronchiectasis, fibrosing alveolitis.
• Cardiac pathologies: infective endocarditis, “blue” heart defects.
• GI diseases: nonspecific ulcerative colitis, Crohn’s disease, chronic hepatitis, primary biliary cirrhosis.

Diagnosis

Orthopedic traumatologists determine the pathology causing finger deformity. Patients are referred to rheumatologists, surgeons, neurologists, and other specialists if indicated. Most often, the following diagnostic procedures are performed:

• Interview and examination. During the conversation, the doctor establishes the time and circumstances of the symptom and identifies other disorders. The doctor examines the dynamics of the disease and determines the nature and severity of external changes, the presence of edema, skin color and temperature, and joint mobility.
• Radiography. X-rays of the fingers or hand are taken in two projections. The radiographs visualize dislocations, fractures, phalangeal configuration disorders, neoplasms, signs of inflammation and degeneration, areas of bone melting.
• CT, MRI. They are recommended in case of insufficient informativeness of X-ray examinations. They allow us to detail the detected changes, accurately determine their localization, nature, and volume, choose the optimal tactics of conservative therapy, and and plan surgical intervention.
• Laboratory tests. Required to confirm hereditary diseases, oncological and inflammatory processes, rheumatic diseases.

The examination plan in secondary osteoarthropathy depends on the features of the underlying pathology. Other methods may be prescribed for diagnostics, such as X-ray OGC, ultrasound of the abdominal cavity, and echocardiography.

Treatment

Pre-hospital care

In case of injuries and inflammatory processes, the elevated position of the limb is shown. To fractures and dislocations, apply cold fingers fixed with a splint or bandaged to each other. Victims with frostbite apply warming bandages. To reduce the severity of pain syndrome, give analgesics. In the exacerbation of chronic inflammation, local remedies are used.

Conservative therapy

Patients with injuries are repositioned and immobilized with a plaster cast. In subcutaneous tendon rupture, the finger is fixed in a state of overextension. In case of frostbite, dressings are applied. The treatment plan may include the following conservative measures:

• Protective regime. It is indicated for patients with injuries, arthrosis, and arthritis in the period of exacerbation. It is recommended to limit the load on the limb, which, in some cases, is made of orthopedic devices.
• Drug therapy. More often, NSAIDs are prescribed. Other drugs used include antibiotics, hormonal drugs, and means to improve blood circulation. In some cases, blockades with a mixture of local anesthetics and corticosteroids are effective.
• Non-medicamentous methods. Physiotherapy, massage, taping, and manual therapy are used.

Patients with syndromic hereditary pathology, diseases of internal organs, accompanied by osteoarthropathy, are treated for the underlying disease.

Surgical treatment

Considering the causes of deformities, the following operations may be performed:

• Traumatic injuries: fixation with spokes, tendon suture in the absence of self-healing, finger amputation, or necrectomy for frostbite.
• Congenital anomalies: interventions for syndactyly, plastic surgery to improve functionality and correct finger shape.
• Arthritis: endoprosthetic replacement of the metacarpophalangeal joints.
• Panaritium: opening, drainage.
• Chondromas: removal of the tumor.

Antibiotics are prescribed in the postoperative period. Comprehensive rehabilitation measures are carried out to improve hand function.

All these treatment options are available in more than 800 hospitals worldwide (https://doctor.global/results/diseases/finger-deformity). For example, Finger reconstruction can be done in following countries:

Turkey$2.0 K in 32 clinics

Germany$7.6 K in 40 clinics

China$8.6 K in 6 clinics

United States$10.4 K in 19 clinics

Israel$30.2 K in 16 clinics.