Clubbing

1. CLUBBING
First described by Hippocrates about
2500yrs ago, hence also called as
Hippocratic finger
ABHIJIT SAMAL
080201386

2. DEFINITION
•Thickening of the tissues at the base of the
finger and toe nails such that the normal angle
between the nail & the digit is filled in.

3. Pathophysiology
•VEGF is the key entity, platelet derived growth
factor stimulated by hypoxia and produced in
diverse malignancies.
•VEGF induces vascular hyperplasia, edema,
and fibroblast or osteoblast proliferation at
peripheral levels in nails

4. CAUSES
•thoracic & non-thoracic
•THORACIC causes: bronchitis, empyema, lung abscess, cystic
fibrosis, Lung Ca, Esophageal Ca,
mesothelioma, Bac. Endocarditis.
»Interstitial lung disease: asbestosis, fibrosing
alveolitis.
»Vascular causes: AV malformations, Cyanotic
heart disease.

•Non-thoracic causes: Hepatic cirrhosis, Ulcerative colitis,
Crohn’s disease.

5. Criteria
•Loss of normal angle between nail and nail
bed.
•Inc. Nail bed fluctuation
•Inc. nail bed curvature in the later stages
•Inc. bulk of soft tissue over the terminal
phalanges

7. Grades of clubbing
•Grade 1: Nail bed fluctuation
•Grade 2: Obliteration of Lovibond angle
•Grade 3: Parrot beaking
•Grade 4: Hypertrophic osteo-
arthropathy(HOA)

8. Drumstick appearance
Parrot beak app.

9. Hypertrophic Osteo-arthropathy
•Earlier known as hypertrophic pulmonary
osteo-arthropathy(HPOA)
•Syndrome of clubbing of the digits, periostitis
of the long bones and arthritis.
•Primary: occurs w/o any underlying cause and
is familial
•Secondary: pulmonary, cardiac, hepatic,
intestinal disease.

10. Hypertrophic Osteo-arthropathy
•Earlier known as hypertrophic pulmonary
osteo-arthropathy(HPOA)
•Syndrome of clubbing of the digits, periostitis
of the long bones and arthritis.
•Primary: occurs w/o any underlying cause and
is familial
•Secondary: pulmonary, cardiac, hepatic,
intestinal disease.