Digital clubbing
| Clubbing | |
|---|---|
| Synonyms | drumstick fingers, watch-glass nails |
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| Clubbing | |
| Classification and external resources | |
| Specialty | Pulmonology |
| ICD-10 | R68.3 |
| ICD-9-CM | 781.5 |
Nail clubbing, also known as digital clubbing, is a deformity of the finger or toe nails associated with a number of diseases, mostly of the heart and lungs. Clubbing for no obvious reason can also occur, but is rare.Hippocrates was probably the first to document clubbing as a sign of disease, and the phenomenon is therefore occasionally called Hippocratic fingers.
Clubbing may be present in one of five stages:
Schamroth's test or Schamroth's window test (originally demonstrated by South African cardiologist Leo Schamroth on himself) is a popular test for clubbing. When the distal phalanges (bones nearest the fingertips) of corresponding fingers of opposite hands are directly (place fingernails of same finger on opposite hands against each other, nail to nail), a small diamond-shaped "window" is normally apparent between the nailbeds. If this window is obliterated, the test is positive and clubbing is present.
Severe clubbing
Front view
Side views
Although many diseases are associated with clubbing (particularly lung diseases), the reports are fairly anecdotal. Prospective studies of patients presenting with clubbing have not yet been performed, and hence there is no conclusive evidence of these associations.
Clubbing is associated with:
Nail clubbing is not specific to chronic obstructive pulmonary disease (COPD). Therefore, in patients with COPD with significant degrees of clubbing, a search for signs of bronchogenic carcinoma (or other causes of clubbing) might be indicated.
A congenital form is also known. This may be inherited either in an autosomal recessive or dominant fashion. In these cases the thumbs are almost always affected: the other fingers may be affected.
A special form of clubbing is hypertrophic pulmonary osteoarthropathy, known in continental Europe as Pierre Marie-Bamberger syndrome. This is the combination of clubbing and thickening of periosteum (connective tissue lining of the bones) and synovium (lining of joints), and is often initially diagnosed as arthritis. It is commonly associated with lung cancer.
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