Clubbing

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Top Contributors - Kalyani Yajnanarayan

This article is currently under review and may not be up to date. Please come back soon to see the finished work! (31/05/2022)

Clinically Relevant Anatomy

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Mechanism of Injury / Pathological Process

Clubbing is often associated with numerous gastrointestinal and cardiorespiratory diseases. Such as:

• Lung cancer
• Cystic Fibrosis
• Bronchiectasis
• Idiopathic pulmonary fibrosis
• Endocarditis
• Congenital heart disease
• Ulcerative colitis
• Crohn's disease
• Liver disease (primary biliary cirrhosis)
  

Clinical Presentation

Stages of digital clubbing.

stage 1: peri-ungual erythema and softening of nail bed

stage 2: increase in the normal 160° angle between the nail bed and the proximal nail fold occurs, resulting in convexity as the nails grow. Eventually, the depth of distal phalanx increases and distal inter-phalangeal joint may become hyper-extensible. At this stage, finger develops a clubbed appearance

Stage 3: Finally, the nail and peri-ungual skin appear shiny and nail develops longitudinal ridging. This whole process usually takes years but in certain conditions, clubbing may develop sub-acutely (e.g. lung abscess, empyema thorasis).

Diagnostic Procedures

As there's no "gold standard" for the evaluation of clubbing, healthcare professionals must rely on their clinical examination skills to verify the diagnosis. Palpation and visual examination are usually sufficient to diagnose advance clubbing, however, early stages are more difficult to detect.

The schamroth sign is the absence of the diamond shaped "window" that normally occurs when the dorsal surfaces of the distal phalanges on opposing fingers are placed together.

Outcome Measures

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Management / Interventions

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Differential Diagnosis

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Resources

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