Clubbing
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Introduction
Diagnosing Clubbing
Picking up on clubbing is in some ways an intuitive thing, but there are some helpful hints as well.
Putting the two matching fingers together, pointing dowards, you should normally be able to see between the two nail beds. In clubbing, this space goes away.
The nail bed can become squishier in clubbing.
Normally, the distal finger is narrower than the DIP (distal interphalangeal) joint, but in clubbing, the opposite is true.
Looking at the finger in profile, there should be an angle of greater than 180 between the nail and the finger just proximal to it. With clubbing, the nail is flat or downwards sloping.
Conditions and Diseases Commonly Associated with Clubbing
Pulmonary and Thoracic
Tumours occurring in the thorax can also cause hypertrophic osteoarthropathy
- primary and metastatic lung cancer
- mesothelioma
- neurogenic diaphragmatic tumors
- bronchiectasis
- cystic fibrosis
- lung abscess
- interstitial pulmonary fibrosis
- empyema (infected pleural space)
Cardiac
- congenital cyanotic heart disease
- subacute bacterial endocarditis
GI and Hepatic
- hepatic cirrhosis
- chronic ulcerative colitis
- Crohn's disease
Other
- hemiplegia
What Causes Clubbing?
No one really knows what clubbing is all about.
Infections of various types, as well as different cancers, can cause clubbing. This suggests circulating factors are involved.
Hemiplegia may cause clubbing due to autonomic dysfunction.
Resources and References
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