Finger clubbing

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You will be asked these at all stages of examination.

Normal fingers
replace with abnormal fingers

Contents

Features

  1. Increased nail curvature
  2. Loss of nail bed angle
  3. Increased nail bed fluctuance
  4. Drum-sticking

Grading

LogoWarningBox4.pngThere are other grading systems out there in the texts but you are well advised to use this one if you aspire to be a chest physician. [1]
  1. Fluctuation and softening of the nail bed
  2. Loss of the normal 15-degree angle between the nail and the cuticle
  3. Accentuated convexity of the nail
  4. Fingertip develops a clubbed appearance
  5. Nail and adjacent skin develop a shiny or glossy change with longitudinal striations of the nail.


  • Scaramoth's sign is when the curvature of the nail bed leads to obliteration of the diamond created by opposing the dorsal surface of the terminal phalanx of identical fingers from either hand

Causes

Vascular endothelial growth factor (VEGF)-A and platelet-derived growth factor (PDGF) play a central role in pathological clubbing[2] which can also be associated with platelet microemboli[3]. Transforming growth factor beta 1 (TGF beta 1) has a role in lung cancer[4]

Cardiac

Respiratory

Gastrointesinal

Familial

  • Autosomal dominant

Primary familial clubbing is called Touraine-Solente-Golé. It has been linked with hereditary prostaglandin synthesis enzyme dysfunction.

NO CLUBBING WITH

History

First described by Hippocrates.

Normal

A normal nail has:

  1. Profile angle not exceeding 176°
  2. Hyponychial angle not exceeding 192°
  3. Phalangeal depth ratio less or equal to 1.0[5]

Links

References