Phalanx: definition, pain, treatments

Definition and location: where is the phalanx located?

THE phalanges are the bones of the fingers of the hands or feet. They are therefore part of the human skeleton. The phalanx has a cylindrical shape, it is articulated. Different muscles insert onto these bone segments, as well as nerves, tendons, cartilage and ligaments.

What is a distal or nail, intermediate, proximal phalanx?

Anatomically, we find at the level of the hand:

• THE carpeswhich are the bones of the wrist joint;
• THE pasterns : 5 in number, these are the bones of the palm of the hand;
• THE proximal phalangesin contact with the metacarpus;
• THE intermediate phalanges : second phalanges of fingers and toes;
• THE distal phalangesunguals or phalanges which carry the nail.

What is the first phalanx?

The phalanges are named according to their position. From the palm to the nail, here is their numbering:

• The first (proximal) phalanx or P1, which succeeds the metacarpus;
• The second (intermediate) phalanx or P2;
• The third (distal) phalanx or P3, on which the nail is located.

How many knuckles in a hand, on the foot?

“On a hand, each finger has three phalanges, apart from the thumb and big toe which have two.specifies Doctor Didier Poivret, rheumatologist. Between these three phalanges and the carpus, which is the middle part of the middle of the hand, we encounter interphalangeal joints. At the end of the phalanges are the nails.”

What is the function of the phalanges?

THE phalanges and the articulations interphalangiennes allow to give agility and dexterity to the fingers.

Pathologies and pain of fingers and toes

All joints of the hand and foot can be the site of osteoarthritis or arthritis.

Osteoarthritis of the fingers

Osteoarthritis is characterized by a progressive thinning of the cartilages of a joint. “Osteoarthritis of the fingers is more common in women and a maternal history of this condition is a known risk factor for the development of osteoarthritis of the fingers. When the cartilage of the fingers thins, pain and difficulty bending your fingers”, explains the rheumatologist. “The risk is, ultimately, the immobilization of the joint. Sometimes nodules, commonly called parrot beaks, and osteophytes by doctors, develop around the joint and form small visible bumps on the fingers. Osteoarthritis sometimes leads to a deviation of the phalanx to the side, resulting in deformation of the fingers. The proposed treatment can, if necessary, be surgical in order to straighten the phalanx and plane the osteophytes. This surgical procedure induces the loss of a little joint mobility but gives a more aesthetic appearance to the hand”.

Arthritis of the hand or feet

Arthritis is a joint inflammation which is characterized by acute pain, especially at night, associated with stiffness in the morning as well as swelling of the joint. “When we press on the joint area, we feel like water, which is a sign of synovium effusion. Arthritis is very painful and affects younger people than osteoarthritis. Some illnesses are more serious than others. This is the case of the rheumatoid arthritisan autoimmune disease whose targeted and effective management helps prevent loss of hand function,” reassures our specialist.

Arthritis can also affect the phalanges of the feet and hands. In the foot, it is the joints between the base of the toe and the instep that are most often affected.

Finger fracture (1st phalanx, thumb, etc.)

One of the most common pathologies of the phalanx is fracture, occurring following trauma, for example by accident or fall. “A fracture of the phalanx of the hand requires rapid treatment by a hand surgeon, the most competent professional to treat this type of trauma. Indeed, a poorly treated fracture can lead to stiffness and chronic pain of the wrist, for example, or to deformities of the fingers.,” warns the doctor.

Osteoarthritis of the thumb

The thumb tendinitis or rhizarthrosis is a common pathology. “This condition is getting better and better. In certain cases, it is preferable to have an operation rather than to carry out infiltrations, which only have a transient effectiveness, whereas an intervention under loco-regional anesthesia will make it possible to obtain a more lasting result, not to mention that “a succession of corticosteroid infiltrations will hamper surgical work”.

Skin psoriasis

The skin psoriasis can lead to pain in the fingers. This type of arthritis can be rapidly progressive; it affects around 5% of people who have skin psoriasis. This condition must be quickly treated to avoid joint destruction and disabling deformities.

Hallux valgus

Hallux valgus or “bunion” is the deformation of the first phalanx at the level of the big toe. “He gets sideways. The treatment initially relies on the installation of an orthosis, with no claim to cure. The surgery is now very effective, less painful than in the past, but the rehabilitation takes place over several weeks.” summarizes Dr D. Poivret.

Claw toes

A claw toe deformity is also one of the conditions that can affect the phalanges of the toes. “The toes retract and their upper part rubs on the shoe. This results in the appearance of a corn that is sometimes very painful. In the event of significant discomfort, surgical operation should be considered..”

Treatments

THE treatments for pain are primarily medicinal. Anti-inflammatories are prescribed with caution, especially in patients with a history of cardiovascular disease or renal insufficiency.

A spa treatment is indicated in cases of osteoarthritis of the fingers.

In the event of arthritis, treatment must be initiated quickly to avoid deformation of the fingers. “Today we have very effective treatments to reduce pain and prevent joint deformities.”

Exams

If arthritis is suspected, the diagnosis is based on a set of tests including of course the clinical examination, but also:

• A x-raywhich is the reference examination to visualize the bones;
• Of the blood test ;
• A ultrasound.

Any trauma to the hand or foot requires an x-ray: it may be a fracture of the phalanges, dislocation or tear of a ligament. Following a shock, it is therefore important to consult a surgeon quickly in order to avoid permanent after-effects.“Ultrasound is useful in arthritis of the hand, because it is the best test to visualize the existence of inflammation of the joint as early as possible,” concludes the rheumatologist.