Dr K K Pandey
You would have observed majority of the people in the age group of 25 to 50 years do suffer from one or the other problem of fingers. It could be either a complaint of persistent mild pain in fingers or appearance of ulcers on finger tips, or blackening of nails and finger tips. If you are a habitual tobacco chewer or a smoker, you then in all probability are nearing a stage of ulcer development. If you a regular user of tobacco-mixed paan masaala, or khaini, or jaffrani patti, believe me you yourself are making a road map for finger amputation.
If your fingers have ulcers or black discoloration, it simply means your hand and fingers are getting less supply of pure blood. If timely management is not instituted, there will definitely be no other outcome except of loss of fingers. If your fingers have constant pain and tingling sensation, this too is an indicator of inadequate blood supply. In such a situation, always seek consultation with a vascular or cardiovascular surgeon instead of a general surgeon.
What causes ulcers on fingers ?
The commonest contributing factors to a finger ulcer are Raynauld’s disease, Buerger’s disease caused by smoking & tobacco chewing, and vasculitis caused due to significant inflammatory swelling of arterial wall. Because of vasculitis, the small arteries get deposition of blood clots inside, that results into complete stoppage of blood flow to the hand. This leads to ulcer & black discoloration of fingers. This stage heralds the beginning of gangrene.
There are two reasons for development of vasculitis. One is hyper sensitivity angiitis disease caused by the abnormal hypersensitivity of the arteries. Another one is immune vasculitis disease caused due to disturbances in the defence mechanism or immune system of the body. The Scleroderma disease tops the list of causative factors of immune vasculitis.
There are other causes too, of finger ulcers. One of the important causes is the unwarranted excessive pressure from outside on the artery which supplies blood to the hand. The external pressure on the artery occurs either in the neck area or at the shoulder. There are many reasons for this external pressure on the artery carrying blood to hand. If in the past you have sustained chest injury in an accident and suffered from fracture of clavicle or first rib, the fractured bones though get united in due course of time but leave a protuberant bony scar at the fracture site. This bony scar compresses the artery situated in the upper part of the chest resulting into inadequate supply of blood to hand. In some individuals, an additional rib emerges abnormally from the spine since birth. This abnormal rib in medical terms is called ‘cervical rib’ which too grows in size as the age advances, and starts pressing the artery which supplies pure blood to hand & fingers. This pressure on the artery causes pain followed by development of finger ulcers.
Sometimes, especially in ladies due to advancing age & lack of exercise, shoulders start drooping down. This puts artery of hand under abnormally excessive & harmful pressure, leading to disturbance in blood flow. Sometimes, due to old injury of neck, the muscles of the neck themselves get constricted permanently and in turn accelerates the process of constriction of adjacent artery too.
How to go about it, if you have ulcer on your finger ?
If you are suffering from finger ulcers, consult immediately a vascular or a cardiovascular surgeon instead of a general surgeon or a skin specialist. Always go to a hospital where facilities of modern investigations like doppler study, digital hypothermic challenge test, digital plethysmography and digital subtraction angiography are available, as the result of these tests determines the future course of treatment in right direction. Before entering a hospital, make sure whether availability of a full-time vascular or a cardiovascular surgeon is there or not.
Treatment in case of a finger ulcer
For treatment of finger ulcers in majority of the cases, medications & observance of certain precautions are required. Strict surveillance to monitor the progress of the disease & effect of treatment is very much essential. In a few cases only surgical intervention is needed. Sometimes, surgical removal of clots from the affected artery is required. In a few selected cases, sometimes special operations like thoracic outlet decompression are performed to take the undue pressure off the artery. In such operations, abnormally – grown cervical rib or the first rib is resected & taken out. Sometimes previously injured & abnormally united clavicle too has to be taken out to relieve pressure on the artery.
If diseased artery is damaged beyond correction, modern surgical techniques like ‘arterial reconstruction’ or ‘arterial bypass’ are employed. For bypass, artificial tubes imported form US & Germany are used. These special operations help in restoration of blood supply to hand and fingers.
What to do if you have ulcers on your fingers?
* Protect your hand & fingers from cold. In winter seasons especially, wear woolen gloves on your hand.
* Do not stand in front of refrigerator when it is open. Never put your hand directly into the deep freezer compartment.
* Avoid using cold or icy water for bath. Use rubber gloves while washing dishes.
* Change your profession or job, if you are working in a food processing industry, or ice cream manufacturing units or in cold storage, where you get a regular exposure to cold water every day.
* Do not smoke. Never use tobacco-mixed paan masaala or tooth paste. Avoid using country-made tobacco preparations like “khaini”, “chaini”, “Hukka”.
* Avoid using tight wrist band or wrist watches having tight straps. Wearing tight rings on your fingers is harmful.
* Avoid direct injury to your hand & fingers. Use of sewing machine is harmful. Avoid regular practice on harmonium & piano.
* Avoid using any detergent or soap especially meant for washing clothes.
* Female patients should avoid using contraceptives.
* Use salads & tomatoes in large quantities. Freshly-cut pineapple if eaten immediately is very beneficial. Use of ginger in significant amount in diet is very advantageous.
* Avoid some specific medicines like ergot preparation (used in headache & migraine), beta-blockers (used in blood pressure), sudafed and actifed used in cold.
* Avoid holding mixi, hair drier, and drilling machines with your hand.
(The author is Senior Vascular & Cardiothoracic Surgeon Indraprastha Apollo Hospitals New Delhi, India)
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