clubbed fingers/toes; clubbing (Hippocratic fingers)
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Introduction
Bulbous enlargement & broadening of the fingertips.
Etiology
- idiopathic inherited autosomal dominant trait
- any disease associated with chronic hypoxia
- cardiac disease
- cyanotic heart disease
- lower extermity cyanosis & toe clubbing associated with Eisenmenger's syndrome
- bacterial endocarditis
- atrial myxoma
- cyanotic heart disease
- pulmonary disease
- lung cancer
- primary & metastatic cancer (35% large cell carcinoma)
- bronchiectasis
- lung abscess, empyema
- mesothelioma
- tuberculosis
- cystic fibrosis
- pulmonary hypertension
- pulmonary arteriovenous shunt - emphysema
- hypertrophic pulmonary osteoarthropathy
- pulmonary fibrosis
- Hamman-Rich syndrome; idiopathic alveolar fibrosis
- idiopathic pulmomary fibrosis (most common cause of clubbing)
- lung cancer
- gastrointestinal disease
- others
- hyperthyroidism
- vascular anomalies of the affected arm
L: lung cancer, lung abscess, lung fibrosis, lung AV malformation
B: benign mesothelioma
N: neurogenic tumors
G: gastrointestinal diseases, i.e. cirrhosis, regional enteritis
Pathology
- hyperplasia of the fibrovascular tissue between the nail matrix & the bony phalynx
- increased blood supply to the fingers
- may be a result of humoral vasodilator
- platelet precursors fail to fragment into platelets in pulmonary circulation
- platelet precursors become trapped in peripheral vasculature releasing PDGF, VEGF, increased vascularity[4]
Clinical manifestations
- thickening & widening of the distal end of the digits, fingers & toes
- increased convexity of the nail fold[8] <picture>
- increased fingertip mass & nail plate curvature[9]
- the angle made by the proximal nail fold & the nail plate (Lovibond's angle) exceeds 180 degrees
- the tissue between the nail plate & the underlying bone has a spongy quality
- cyanosis is present with cyanotic heart disease & some forms of pulmonary disease
More general terms
More specific terms
Additional terms
References
- ↑ Color Atlas & Synopsis of Clinical Dermatology, Common & Serious Diseases, 3rd ed, Fitzpatrick et al, McGraw Hill, NY, 1997, pg 502
- ↑ Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 720
- ↑ Harrison's Principles of Internal Medicine, 13th ed. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1994, pg 183
- ↑ 4.0 4.1 Spicknall KE et al, Clubbing: an updated on diagosis, differential diagnosis, pathophysiology and clinical relevance J Am Acad Dermatol 2005; 52:1020 PMID: https://pubmed.ncbi.nlm.nih.gov/15928621
- ↑ Myers KA, Farquhar DR. The rational clinical examination: does this patient have clubbing? JAMA. 2001;286:341-7. PMID: https://pubmed.ncbi.nlm.nih.gov/11466101
- ↑ Sridhar KS, Lobo CF, Altman RD. Digital clubbing and lung cancer. Chest 1998;114:1535-37. PMID: https://pubmed.ncbi.nlm.nih.gov/9872183
- ↑ Naeije R. Hepatopulmonary syndrome and portopulmonary hypertension. Swiss Med Wkly. 2003;133:163-9. PMID: https://pubmed.ncbi.nlm.nih.gov/12715285
- ↑ 8.0 8.1 Clubbing, Wikipedia (accessed 06/26/06) <picture> http://en.wikipedia.org/wiki/Clubbing
- ↑ 9.0 9.1 Medical Knowledge Self Assessment Program (MKSAP) 17, 18. American College of Physicians, Philadelphia 2015, 2018
Medical Knowledge Self Assessment Program (MKSAP) 20 American College of Physicians, Philadelphia 2025 - ↑ 10.0 10.1 Schwartz RA, James WD (image) Medscape: Clubbing of the Nails http://emedicine.medscape.com/article/1105946-overview
- ↑ 11.0 11.1 DermNet NZ (images) Hypertrophic osteoarthropathy and digital clubbing http://www.dermnetnz.org/systemic/clubbing.html