Obliteration of the angle between the nail and the nailbed is the first sign of clubbing and its most constant feature; indeed, many require it for the diagnosis. Because it can be easily detected and precisely defined, the examiner should rely on this sign when uncertain if a patient's fingers are truly clubbed.
Clubbing is present in one of five stages: No visible clubbing - Fluctuation (increased ballotability) and softening of the nail bed only. No visible changes of nails. Mild clubbing - Loss of the normal <165° angle (Lovibond angle) between the nailbed and the fold (cuticula).
Lovibond angle sign: When you view your fingernail from the side, it should have a slight dent at the base. This dent, known as the Lovibond angle, makes a slight upward curve as your nail grows toward your fingertip. In the early stages of nail clubbing, your nail and nail bed look flat from the side.
Grade 1: The nail bed becomes soft. Grade 2: There are changes in the angle of the nail fold (the skin beneath the cuticle that holds the nail in place). Grade 3: The nail takes on a more obvious curve. Grade 4: The end of the finger becomes thicker (club-like).
Grades of clubbing
1: Fluctuation and softening of nail-beds. 2: Obliteration of the onychodermal angle (>160º) 3: Accentuated convexity of nail. 4: Clubbed appearance of the fingertip.
Stage 3: Finally, the nail and peri-ungual skin appear shiny and nail develops longitudinal ridging. This whole process usually takes years but in certain conditions, clubbing may develop sub-acutely (e.g. lung abscess, empyema thorasis).
Finger clubbing generally takes years to develop. But it can happen quicker in certain conditions such as a lung abscess.
The Schamroth window test can be used to identify or confirm clubbing. If 2 opposing fingers are held back to back against each other, a diamond-shaped space should normally appear between the nail beds and the nails of the 2 fingers. In clubbing, this space (or window) is missing.
Clubbing tends to affect the thumb and forefinger first before progressing to the other fingers. Symptoms of clubbed fingers typically impact both hands. The condition is painless.
As with the treatment and management of digital clubbing, the prognosis is highly dependent on the underlying etiology. If the etiology is reversible, then clubbing will reverse. But if the condition is chronic or associated with a malignancy, clubbing is long term.
In clubbing, the angle flattens out and increases as the severity of the clubbing increases. If the angle is greater than 180°, definitive clubbing exists. An angle between 160-180° falls in a gray area and may indicate early stages of clubbing or a pseudoclubbing phenomenon.
It can be graded into 5 stages i.e. Grade 1: fluctuation and softening of the nail bed, Grade 2: increase of the hyponychial angle, Grade 3: accentuated convexity of the nail, Grade 4: clubbed appearance of the fingertip, and Grade 5: development of a shiny or glossy change in nail and adjacent skin1.
Koilonychia is an abnormal shape of the fingernail. The nail has raised ridges and is thin and curved inward. This disorder is associated with iron deficiency anemia.
For example: If a bond is transferred for Rs. 5 lakh to the spouse or daughter-in-law without adequate consideration and interest of Rs. 20,000 on such bond is clubbed in the hands of the transferor. However, if the spouse or daughter-in-law further earns any income from such interest of Rs.
Clubbing may be present as an hereditary anomaly in selected families. When this anomaly is observed in a presumably healthy person, inquiry into the duration of the abnormality and the possible familial distribution may be rewarding.
Single hippocratic (clubbed) finger revealing an underlying enchondroma. To the Editor: Single clubbed or hippocratic finger is a very rare condition that may reveal the presence of an underlying tumor of the distal phalanx. We present here a patient with a solitary clubbed finger as a result of an enchondroma.
Clubbing may make it difficult for your medical team to get an accurate reading of the oxygen levels in your blood when using a fingertip pulse oximetry machine. They may have to use an ear clip instead.
The Herbst triad is defined by the presence of GERD associated with digital clubbing, anemia, and hypoalbuminemia caused by protein–losing enteropathy (3). Indeed, the majority of reported cases had Herbst's triad (digital clubbing, anemia, and GERD) also low albumin levels.
Pseudoclubbing is defined as an overcurvature of the nails in both the longitudinal and transverse axes, with preservation of a normal Lovibond angle.
Board-certified dermatologists specialize in diagnosing and treating the skin, hair, and nails.
Finger clubbing, also called "drumstick fingers" or Hippocratic fingers, is a common clinical sign mainly seen in patients with heart or lung disease. The term is used to describe an enlargement of the distal phalanges of the fingers, giving them a drumstick or club-like appearance.
Very pale nails
Healthy nails are generally pink. Very pale nails may indicate illnesses, such as anemia, congestive heart failure or liver disease.