Clubbing is the selective bulbous enlargement of the distal segments of fingers or toes due to proliferation of connective tissues ( Fig. 10 ).

Figure 10
Clubbing .
Note the exaggerated longitudinal curvature and the loss of angle between the nail and the nailbed .

Causes

Respiratory

  • Bronchial carcinoma

  • Chronic suppurative lung disease

    • Bronchiectasis

    • Lung abscess

    • Empyema

    • Cystic fibrosis

  • Interstitial lung disease (fibrosing alveolitis, pulmonary fibrosis)

Cardiovascular

  • Infective endocarditis • (common in developing countries)

  • Congenital cyanotic heart disease

Gastrointestinal

  • Cirrhosis

  • Ulcerative colitis

  • Crohn’s disease

  • Coeliac disease

Other

  • Graves’ disease (hyperthyroidism)

  • Familial

Clubbing is said to be present when there is loss of the normal angle between the base of the nail and the nailfold. In the presence of clubbing, when the fingernails from each hand are placed together, the gap is lost, and this is known as Schamroth’s sign. Other features are increased curvature of the nailbed (in all directions), sponginess or fluctuation and expansion of the end of the digit to resemble a drumstick.

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