The term drumstick fingers is used to describe distended toe and finger end links. Drumbeat fingers are not a condition in their own right, but are a symptom of certain heart and lung conditions.
What is drumstick finger?
The medical term – digiti hippocratici – describes a distension of the finger end links with accompanying swelling of the soft tissues. Drumbeat fingers (digiti hippocratici) are also known as piston fingers. The medical term describes a distension of the finger end links with accompanying swelling of the soft tissues. The fingers have a piston-like appearance. Drumbeat fingers are often accompanied by watch glass nails. The symptom is seen in diseases of the liver, heart, lungs, or gastrointestinal tract.
Causes
The most common causes of drumbeat fingers include lung disease and heart disease. Thus, this medical phenomenon is often observed in lung cancer. However, other lung diseases can also cause piston fingers. These include bronchiectasis, for example. Bronchiectasis are sac-like dilatations of the bronchial tubes. These are caused by recurrent infections. Emphysema, an overinflation of the air sacs (alveoli) in the lungs, can also cause drumbeat fingers. Emphysema is usually the result of chronic obstructive bronchitis (COPD). Cystic fibrosis is a congenital metabolic disease in which a viscous mucus is produced in the airways and lungs. In this case, drumbeat fingers can be observed just as in pulmonary tuberculosis. In some cases, the distended fingers can be attributed to chronic heart disease or heart defects. Inflammation of the inner lining of the heart (endocarditis) or the layer of heart muscle (myocarditis), as well as the rather rare cardiac tumors, may also be causes. Drumbeat fingers can also develop in the context of liver disease. The main cause here is liver cirrhosis. In cirrhosis of the liver, liver tissue is irreversibly destroyed and replaced by connective or scar tissue. Causes of liver cirrhosis include chronic hepatitis C and alcohol abuse. Gastrointestinal diseases can also lead to drumbeat fingers. The most common triggers here are chronic inflammatory bowel diseases such as Crohn’s disease or ulcerative colitis. People with gastrointestinal tuberculosis, polyps in the colon, chronic amoebic dysentery or colon cancer may also develop distended fingers. In all of these conditions, drumstick fingers show up on both hands. There are few causes for unilateral piston fingers. Conceivable triggers include aneurysms, inflammation of the lymphatics, and Pancoast tumor. Pancoast tumor is a specific form of lung cancer. It is a rapidly growing bronchial carcinoma at the top of the lung.
Diseases with this symptom
- Cystic Fibrosis
- Tuberculosis
- Heart defect
- Crohn’s disease
- Colorectal cancer
- Endocarditis
- Heart muscle inflammation
- Alcoholism
- Ulcerative colitis
- Pulmonary emphysema
- Cardiac tumor
- Liver cirrhosis
- Hepatitis C
- COPD
- Bronchiectasis
Diagnosis and course
Drumstick fingers are swollen and enlarged. In the area of the distal phalanges, soft tissue thickening is also evident. This piston-like distension is caused by a lack of oxygen in the blood. This oxygen deficiency (hypoxia) stimulates the production of growth substances. As a result, many new small blood vessels (capillaries) are formed. Furthermore, additional bone tissue is formed. This is also the body’s reaction to the increased stress on the fingertips. The swelling of the fingers is thus caused by the additional capillaries and the increase in collagenous bone tissue. Drumbeat fingers often occur in association with watch glass nails. Due to the thickening of the finger end links, the nails are also altered. They are larger than nails of healthy people, curved outward and roundish in shape. Because not enough oxygen reaches the fingers despite the new capillaries, they are often bluish in color. In medical terminology, this blue coloration is called cyanosis.
Complications
Drumstick fingers develop, for example, in lung disease, especially bronchial carcinoma. As the cancer progresses, blood and secretions may be coughed up.In addition, cancer cells can decay, causing high fever in the affected person. Lung cancer not infrequently leads to death. However, emphysema or tuberculosis can also lead to shortness of breath and chest pain in the affected person. Heart weakness (cardiac insufficiency) can degenerate into cardiac arrhythmias. In atrial fibrillation, blood clots can form on the wall, break loose and be carried with the bloodstream. This results in strokes or pulmonary embolism, which is also characterized by chest pain and shortness of breath. Ventricular fibrillation can progress to circulatory death and eventually cardiac death. Chronic liver disease, such as hepatitis, can progress to cirrhosis. The liver can no longer function properly and not enough proteins are produced. This leads to edema and clotting problems. Enlargement of the spleen with corresponding upper abdominal pain can also result. In addition, cirrhosis of the liver increases the risk of developing liver carcinoma. In chronic inflammatory bowel diseases such as Crohn’s disease, there is a risk of internal bleeding. In addition, obstruction of the intestine (ileus) can occur, which can be life-threatening. The risk of developing colorectal cancer is also increased.
Treatment and therapy
Drumbeat fingers are always an indication of a serious underlying disease. Various diagnostic procedures can be used for clarification. At the beginning there is always a detailed anamnesis. During the anamnesis interview, the attending physician asks about symptoms, previous illnesses, medications, and other relevant background information. A blood gas analysis can be used to determine the oxygen deficiency in the blood. If a lung disease is suspected, X-ray diagnostics can provide further information. Computer tomography or magnetic resonance imaging are also used. Bronchoscopy and mediastinoscopy can be used to assess the condition of the lungs. Spirometry is used to quantify the performance of the lungs. Diseases of the heart usually require an ECG examination first. Further diagnostics are then performed by sonography. If cystic fibrosis is suspected, the blood is first examined. Here, an elevated blood level of the enzyme trypsin is found. If there is increased trypsin in the blood, a sweat test is performed. In people who have cystic fibrosis, the level of sodium and chloride in sweat is increased. In inflammatory bowel disease, diagnosis is made by ultrasound and endoscopy. The diagnosis is also confirmed by taking and examining a tissue sample. Indications of liver cirrhosis are provided by the blood count. The liver can no longer perform its detoxification task adequately, so that waste products accumulate in the blood. In addition, liver values are elevated. Drumbeat fingers can only be eliminated by treating the original disease. If the chronic hypoxia recedes, drumbeat fingers and watch glass nails also disappear. Tumors of the lungs are usually treated with chemotherapeutic agents. However, the prognosis is rather poor, especially in the case of Pancoast tumor. Pulmonary emphysema is also not reversible. Hypoxia is treated with drugs. For this purpose, so-called bronchodilators are administered. These dilate the airways and thus reduce the shortness of breath. Glucocorticoids and PDE-4 inhibitors are also used. Cystic fibrosis is also not curable. Patients must regularly inhale mucolytic medications. In severe cases, a lung transplant may be required. If drumbeat fingers are due to heart failure, heart-strengthening drugs such as digitalis preparations can be used. Liver cirrhosis is mainly treated with nutritional therapy. Affected individuals must substitute vitamins and imperatively avoid any liver toxins.
Outlook and prognosis
In drumbeat fingers, the patient’s fingers are severely swollen. In addition to this symptom, most patients also suffer from what is known as clock glass nails. If not enough oxygen reaches the fingers through the blood, the fingers turn blue. Over a long period of time, this can cause great damage to the extremities. In many cases, drumstick fingers occur as a symptom of cancer. In this case, no general prediction of the disease is possible.However, the symptom also occurs during diseases and inflammations in the lungs and can thus lead to shortness of breath, abnormal breathing sounds and chest pain. Here, in the worst case, a stroke can occur. In the case of drumbeat fingers, a doctor should be consulted in any case. Usually, an examination is performed with the help of X-rays or an MRI scan and provides information about the cause of this symptom. Drumbeat fingers will disappear only if the underlying condition is also successfully treated.
Prevention
Drumbeat fingers can only be prevented indirectly by preventing possible causative diseases. For most diseases, this is only partially possible. However, since smoking and alcohol are risk factors for numerous diseases that result in drumstick fingers, these stimulants should be avoided as much as possible.
What you can do yourself
Since drumstick fingers are always based on a causative disease, joining a self-help group is often the right step. Depending on the underlying disease, this could be Alcoholics Anonymous, a self-help group for tumor or cancer patients, or even for people suffering from cystic fibrosis. The causes of the “misshapen” fingers are always serious and psychologically often very stressful, so that the exchange with those affected can be a great help for some. A decrease in the severe swelling of the fingers can only be achieved by treating the underlying disease. If the chronic undersupply of oxygen to the fingers can be eliminated, the drumstick fingers can also regenerate and return to their original shape. In any case, it is important to seek medical treatment immediately if drumstick fingers appear (often associated with clock glass nails) and to refrain from self-treatment with hand baths or similar, as no improvement of the symptoms can be expected. Alcohol and cigarettes should be avoided in any case, since they additionally impair the oxygen supply to the extremities. Also, these stimulants can negatively influence the underlying diseases or even cause them in the first place.
