Madonna fingers are thin, elongated fingers that are a symptom of an overriding condition. It is a variant of arachnodactyly, which often occurs in the setting of sclerodactyly. Treatment of madonna fingers depends on the primary cause, but usually involves physical therapy steps to preserve full or partial range of motion.
What are madonna fingers?
Statues of the Virgin Mary were equipped with extremely thin fingers in early times. It is from those same statues of the Madonna that the term Madonna fingers originated. Madonna fingers are unusually thin-looking fingers that are usually the symptom of a higher-level condition. Thin fingers in themselves do not necessarily have pathological value. They only have pathological value if the shape of the fingers is associated with other symptoms, especially with dermal symptoms such as waxy skin or with restricted movement, which can be caused by a bent posture or pathological deposits in the finger joints. Especially a bent posture of the long, thin fingers fits again to the eponymous Maria depiction. Depending on the cause, Madonna fingers are associated with more or less severe pain. As primary cause or causative underlying disease different clinical pictures come into question. Sclerodactyly is sometimes most commonly associated with the symptom of Madonna fingers. Madonna fingers are a form of arachnodactyly. Arachnodactyly does not necessarily have disease value, but may nonetheless refer to disease in practice.
Causes
Arachnodactyly in the sense of narrow and long grown fingers can be a physiological gestalt variant. The term madonna fingers is usually used only when arachnodactyly is a disease symptom. A disease associated with Madonna fingers is sclerodactyly, in which the fingers are not only exceptionally thin, but often additionally curved. In this disorder, in addition to thinness and elongation, the main symptoms are skin atrophy and restricted movement due to painful swelling and contractures of the finger joints. Apart from sclerodactyly, acrosclerosis may also be associated with Madonna fingers, which in turn is associated with necrosis of the fingertips and storage of calcium salts in the sense of calcinosis. In addition, madonna fingers may be the symptom of a malformation syndrome. In this context, the long and narrow fingers are typical for Marfan syndrome, for example. The syndrome causes a disease of the connective tissue due to an autosomal dominant inherited mutation.
Diseases with this symptom
- Marfan syndrome
Diagnosis and course of the disease
Patients with Madonna fingers have unusually thin, usually long fingers. As a rule, Madonna fingers are associated with other symptoms that depend on the causative disease. Often, for example, an additional scleroderma is present, in which fibrosis and sclerosis of the skin connective tissue form. Especially in the context of progressive systemic scleroderma, the patients’ skin is waxy and hard. For this reason, their thin fingers are typically affected by restricted movement and are held in a curved rigid posture. Sclerodactyly and acrosclerosis are often associated with madonna fingers. In such a case, painful cupped necrosis occurs on the Madonna fingers, causing the tissue to die. In addition, calcinosis occurs in the area of the fingers. Often the cuticles of the patients are sclerotized and painful. The thin fingers may be additionally shortened due to acroosteolysis. In the context of Marfan syndrome, Madonna fingers are associated with many other symptoms that largely affect the connective tissue. In this context, cardiovascular symptoms and eye complaints should be mentioned in addition to skeletal symptoms. Madonna fingers can be a reason for the physician to suspect various diseases, depending on the additional symptoms present. The physician determines the symptom itself by means of visual diagnosis. In most cases, he or she will additionally use imaging techniques such as radiography to accurately document the unusual finger shape. The prognosis for patients with madonna fingers depends on the causative disease.
Complications
The patient usually suffers increasing and painful limitation of hand movement due to untreated Maddonen fingers. Apart from this, Maddonen’s fingers themselves have no complications. As a symptom of systemic sclerosis, however, they are extremely worrisome because this chronic disease, undetected, can lead to death in the worst case. The symptoms of the autoimmune disease, in which the skin changes due to an excess of collagen, initially develop very slowly and painlessly. The associated skin hardenings cannot be cured. Therapy can only alleviate the symptoms or slow down the course of the disease. Since, for example, an infestation of the lungs or other internal organs can have severe consequences such as pulmonary fibrosis or cardiac insufficiency, medical treatment is inevitable in systemic sclerosis. Madonna fingers should definitely be taken seriously as one of its first signs. However, because systemic sclerosis as a chronic autoimmune disease is not easy to treat, it is imperative to consult an experienced physician to avoid complications. The German Network on Systemic Scleroderma has therefore published a list of clinics and contacts to help patients find the right doctor.
When should you see a doctor?
In most cases, madonna fingers should definitely be examined and treated by a doctor. This condition usually leads to uncomfortable discomfort and restrictions on the patient’s movement, and therefore should not be left untreated. A doctor must be consulted when there is swelling and severe pain in the fingers, and the affected person is restricted in his daily life and living as a result. In most cases, Madonna fingers are not the only symptom. Furthermore, it is not uncommon to also experience discomfort in the eyes and thus reduced vision. With this symptom, too, a doctor must be consulted and treatment must be given. In acute emergencies, the patient must contact an emergency doctor or hospital to treat Madonna fingers. Heart failure may also be associated with Madonna fingers and should never be left untreated.
Treatment and therapy
An important aspect of therapy for madonna fingers is preservation of range of motion and thus manual dexterity. Most overriding conditions with symptomatic madonna fingers can lead to severe impairments in daily living if left untreated in the late stages. These impairments are prevented primarily by movement therapy measures. In physiotherapy, those affected regularly exercise their fingers and thus maintain their mobility. All further therapy steps depend on the respective superordinate disease. Dermal symptoms and pain symptoms can be reduced, for example, in the form of cold protection and greasing care. Since Madonna fingers are only a symptom, all treatment steps mentioned up to this point are to be understood as a symptomatic form of therapy. In addition to symptomatic treatment of the fingers, there is usually a causal treatment of the underlying disease that addresses the cause of the finger symptoms. In diseases such as Marfan syndrome, causal therapy is not possible because the disease is caused by a mutation. In such cases, only symptomatic treatment takes place. In Marfan syndrome, prevention of severe scoliosis is especially crucial.
Outlook and prognosis
In many cases, Madonna fingers cause psychological discomfort, as affected individuals do not feel attractive. This can likewise result in inferiority complexes and decreased self-esteem. Likewise, those affected suffer from restrictions in movement due to the unhealthy and curved posture of the fingers. The posture is rigid and does not allow for dynamic movement, as would be the case with ordinary and healthy fingers. Pain also occurs on the fingers. It is not uncommon for the symptom of madonna fingers to affect the eyes as well, causing eye discomfort. In this case, the visual acuity may be reduced. If there are other changes to the skin in addition to Madonna fingers, the heart may also be affected, resulting in cardiac insufficiency.Autoimmune disease may also develop, reducing the patient’s life expectancy. In most cases, treatment is symptomatic and aims to eliminate the movement restrictions. Relatively good results can be achieved with the help of therapies. Further complications and discomfort occur when the affected person also has scoliosis.
Prevention
Madonna fingers can be prevented only to the extent that the causative diseases can be prevented. In Marfan syndrome in particular, one of a few preventive measures is genetic counseling during the family planning phase. If necessary, those affected can decide not to have children of their own in order not to pass on the syndrome. The extent to which such a decision is necessary for affected individuals can only be determined on a personal basis.
What you can do yourself
Abnormally thin and severely cramped fingers are not only visually unattractive, but are also often accompanied by pain. Meanwhile, there are some self-treatment options and preventive measures. The first rule is to avoid cold, for example by wearing gloves or heat packs. In addition, the fingers should be kept in motion to counteract a permanently bent, rigid posture, for example through physiotherapy exercises. The goal of movement therapy is the manual mobilization of the joints and the restoration of a natural flow of movement. The individual finger exercises should be performed several times a day if possible. Regular hand massages also help. Electrotherapy and acupuncture are equally good options. Ginko extracts have shown significant results in long-term studies. A time-honored home remedy is kneading the hands with warmed hulled millet. In general, strict care should be taken not to dry out the skin. Tobacco products should be avoided, as nicotine aggravates the clinical picture. Soaps are also not advisable, because they usually damage the acid shield of the skin. Often greasing the fingers with lotions, creams or ointments that promote blood circulation prevents the skin from becoming waxy hard.
