Finger Clubbing

NAME OF PATHOLOGY: Finger Clubbing

Definition: Clubbing is a thickening and broadening of the bulbous fleshy portion of the fingers under the nails. The nail becomes curved both longitudinally and laterally. As the underlying condition progresses the curvature becomes more prominent. Curvature of the nail alone may not be significant to diagnose clubbing and should be backed up by the softening of the nailbed. Therefore apparent clubbing may have no significance in a healthy individual.

Causes: Diseases of the lungs: Bronchiectasis, (ie from cystic fibrosis), Abscess or Empyema, Bronchogenic cancinoma, Pneumoconiosis, Pulmonary sepsis, Chronic infections, Fibrosing alveolitis. Diseases of the heart: Bacterial endocarditis, Cyanotic congenital heart disease. Abdominal pathologies: Cirrhosis of the liver, Inflammatory bowel disease e.g. Crohn?s disease, In non pathological cases finger clubbing (of congenital origin) does not signify pathology. Also note that on careful examination the nail and nailbed will not behave as with pathological cases.

Examination: It is best assessed in the early stages when the nail bed becomes softer so that you can rock the nail from side to side. Clubbing can also be assessed by placing two nails back to back against a light and trying to observe a diamond-shape formed by the two nailbed angles. Like this...In clubbing this is obliterated.

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