Finger clubbing
From Ganfyd
You will be asked these at all stages of examination.
Contents |
Features
- Increased nail curvature
- Loss of nail bed angle
- Increased nail bed fluctuance
- Drum-sticking
Grading
 | There 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] |
- Fluctuation and softening of the nail bed
- Loss of the normal 15-degree angle between the nail and the cuticle
- Accentuated convexity of the nail
- Fingertip develops a clubbed appearance
- 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
Web Resources for Finger clubbing
Relevant Clinical Literature
UK Guidance
Other Wikis
Medpedia on Finger clubbing (Less technical, good quality control)
Wikipedia on Finger clubbing (Less technical, ? quality control)
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
- Lung cancer
- Lung abscess
- Empyema
- Bronchiectasis
- Cryptogenic fibrosing alveolitis
- Cystic fibrosis
- Mesothelioma
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:
- Profile angle not exceeding 176°
- Hyponychial angle not exceeding 192°
- Phalangeal depth ratio less or equal to 1.0[5]
Links
- JAMA Review on Clubbing
- KS Sridhar, CF Lobo and RD Altman Digital clubbing and lung cancer Chest 1998;114;1535-1537
References
- ↑ Altman RD, Tenenbaum J. Hypertrophic Osteoarthropathy In: Kelly WN, Harris ED, Ruddy S, et al, eds. Textbook of Rheumatology. 5th ed. Philadelphia: W.B Saunders Company, 1997; 1514–1520
- ↑ Atkinson S, Fox SB. Vascular endothelial growth factor (VEGF)-A and platelet-derived growth factor (PDGF) play a central role in the pathogenesis of digital clubbing. The Journal of pathology. 2004;203:721-8. (Direct link – subscription may be required.)
- ↑ Fox SB, Day CA, Gatter KC. Association between platelet microthrombi and finger clubbing. Lancet. 1991;338:313-4.
- ↑ Hirakata Y, Kitamura S. Elevated serum transforming growth factor beta 1 level in primary lung cancer patients with finger clubbing. European journal of clinical investigation. 1996;26:820-3.
- ↑ Myers KA, Farquhar DR. The rational clinical examination. Does this patient have clubbing? JAMA : the journal of the American Medical Association. 2001;286:341-7.
