Schamroth's window test
| 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".
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.
Primary hypertrophic osteoarthropathy is HPOA without signs of pulmonary disease. This form has a hereditary component, although subtle cardiac abnormalities can occasionally be found. It is known eponymously as the Touraine–Solente–Golé syndrome. This condition has been linked to mutations in the gene on the fourth chromosome (4q33-q34) coding for the enzyme 15-hydroxyprostaglandin dehydrogenase (HPGD); this leads to decreased breakdown of prostaglandin E2 and elevated levels of this substance.
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