History

The development of clubbing usually is gradual enough that many patients are unaware of its presence; however, some patients may report swelling of the distal portion of the digits, which may be bilateral or unilateral or may involve a single digit. Unilateral clubbing can be seen in hemiplegia.^[45]

Although clubbing typically is painless, it rarely may present with pain in the fingertips.

Rapid postoperative resolution of clubbing in a few days was described in a patient with aortic and mitral valve replacement due to infective endocarditis.^[46]

Hypertrophic osteoarthropathy may occur as an isolated calcaneal periostitis bilaterally.^[47]

Finger clubbing may be a clue to an underlying systemic disorder, including vasculitis with chronic hepatitis C and type II mixed cryoglobulinemia.^[48]

Complications

Since clubbing is a clinical finding, no direct complications occur, except for cosmetic concerns. The complications of the underlying disease resulting in clubbing may be numerous considering the wide spectrum of diseases that are associated with clubbing. The discussion of these is beyond the scope of this article.

Patients with hereditary hemorrhagic telangiectasia may have develop pulmonary arteriovenous malformations, which may induce clubbing, cyanosis, and other findings, possibly leading to complications such as stroke or brain abscess if untreated.^[49]

Differential Diagnoses

Goyal S, Griffiths AD, Omarouayache S, Mohammedi R. An improved method of studying fingernail morphometry: application to the early detection of fingernail clubbing. J Am Acad Dermatol. 1998 Oct. 39(4 Pt 1):640-2. [QxMD MEDLINE Link].
Pallarés-Sanmartín A, Leiro-Fernández V, Cebreiro TL, Botana-Rial M, Fernández-Villar A. Validity and reliability of the Schamroth sign for the diagnosis of clubbing. JAMA. 2010 Jul 14. 304(2):159-61. [QxMD MEDLINE Link].
Li ZT, Wang D, Wang S. Successful treatment of pachydermoperiostosis with etoricoxib in a patient with a homozygous splice-site mutation in the SLCO2A1 gene. Br J Dermatol. 2016 Feb 15. [QxMD MEDLINE Link].
Kumar U, Bhatt SP, Misra A. Unusual associations of pachydermoperiostosis: a case report. Indian J Med Sci. 2008 Feb. 62(2):65-8. [QxMD MEDLINE Link].
Saghafi M, Azarian A, Nohesara N. Primary hypertrophic osteoarthropathy with myelofibrosis. Rheumatol Int. 2008 Apr. 28(6):597-600. [QxMD MEDLINE Link].
Castori M, Sinibaldi L, Mingarelli R, Lachman RS, Rimoin DL, Dallapiccola B. Pachydermoperiostosis: an update. Clin Genet. 2005 Dec. 68(6):477-86. [QxMD MEDLINE Link].
Seifert W, Kühnisch J, Tüysüz B, Specker C, Brouwers A, Horn D. Mutations in the prostaglandin transporter encoding gene SLCO2A1 cause primary hypertrophic osteoarthropathy and isolated digital clubbing. Hum Mutat. 2012 Feb 13. [QxMD MEDLINE Link].
Khan AK, Muhammad N, Khan SA, Ullah W, Nasir A, Afzal S, et al. A novel mutation in the HPGD gene causing primary hypertrophic osteoarthropathy with digital clubbing in a Pakistani family. Ann Hum Genet. 2017 Dec 28. [QxMD MEDLINE Link].
Joshi A, Nepal G, Shing YK, Panthi HP, Baral S. Pachydermoperiostosis (Touraine-Solente-Gole syndrome): a case report. J Med Case Rep. 2019 Feb 21. 13 (1):39. [QxMD MEDLINE Link].
Tariq M, Azeem Z, Ali G, Chishti MS, Ahmad W. Mutation in the HPGD gene encoding NAD+ dependent 15-hydroxyprostaglandin dehydrogenase underlies isolated congenital nail clubbing (ICNC). J Med Genet. 2009 Jan. 46(1):14-20. [QxMD MEDLINE Link].
Ishizuka T, Fujioka K, Mori I, Takeda T, Fuwa M, Ikeda T, et al. Primary hypertrophic osteoarthropathy with severe arthralgia identified by gene mutation of SLCO2A1. Mod Rheumatol Case Rep. 2021 Jan 18. 1-7. [QxMD MEDLINE Link].
Nakamura J, Halliday NA, Fukuba E, Radjenovic A, Tanner SF, Emery P, et al. The Microanatomic Basis of Finger Clubbing -- A High-resolution Magnetic Resonance Imaging Study. J Rheumatol. 2014 Mar. 41(3):523-7. [QxMD MEDLINE Link].
Dickinson CJ, Martin JF. Megakaryocytes and platelet clumps as the cause of finger clubbing. Lancet. 1987 Dec 19. 2(8573):1434-5. [QxMD MEDLINE Link].
Hugosson C, Bahabri S, Rifai A, al-Dalaan A. Hypertrophic osteoarthropathy caused by lipoid pneumonia. Pediatr Radiol. 1995. 25(6):482-3. [QxMD MEDLINE Link].
Shneerson JM. Digital clubbing and hypertrophic osteoarthropathy: The underlying mechanisms. Br J Dis Chest. 1981 Apr. 75(2):113-31. [QxMD MEDLINE Link].
Fawcett RS, Linford S, Stulberg DL. Nail abnormalities: clues to systemic disease. Am Fam Physician. 2004 Mar 15. 69(6):1417-24. [QxMD MEDLINE Link].
Sridhar KS, Lobo CF, Altman RD. Digital clubbing and lung cancer. Chest. 1998 Dec. 114(6):1535-7. [QxMD MEDLINE Link].
Grathwohl KW, Thompson JW, Riordan KK, Roth BJ, Dillard TA. Digital clubbing associated with polymyositis and interstitial lung disease. Chest. 1995 Dec. 108(6):1751-2. [QxMD MEDLINE Link].
Kanematsu T, Kitaichi M, Nishimura K, Nagai S, Izumi T. Clubbing of the fingers and smooth-muscle proliferation in fibrotic changes in the lung in patients with idiopathic pulmonary fibrosis. Chest. 1994 Feb. 105(2):339-42. [QxMD MEDLINE Link].
West SG, Gilbreath RE, Lawless OJ. Painful clubbing and sarcoidosis. JAMA. 1981 Sep 18. 246(12):1338-9. [QxMD MEDLINE Link].
Loredo JS, Fedullo PF, Piovella F, Moser KM. Digital clubbing associated with pulmonary artery sarcoma. Chest. 1996 Jun. 109(6):1651-3. [QxMD MEDLINE Link].
Smahi M, Lakranbi M, Choumi I, Elbiaz M, Amara B, Benjelloun MC. [Nail clubbing and lung hydatid cysts]. Rev Mal Respir. 2010. 27(1):99-101. [QxMD MEDLINE Link].
Jancauskaite D, Rudiene V, Mataciunas M, Zakarkaite D, Petrulioniene Z, Gumbiene L. Cardiac imaging in a patient with differential clubbing. Kardiol Pol. 2020 Feb 21. [QxMD MEDLINE Link].
Pineda CJ, Guerra J Jr, Weisman MH, Resnick D, Martinez-Lavin M. The skeletal manifestations of clubbing: a study in patients with cyanotic congenital heart disease and hypertrophic osteoarthropathy. Semin Arthritis Rheum. 1985 May. 14(4):263-73. [QxMD MEDLINE Link].
Gouriet F, Tissot-Dupont H, Casalta JP, Hubert S, Fournier PE, Edouard S, et al. Marseille scoring system for empiric treatment of infective endocarditis. Eur J Clin Microbiol Infect Dis. 2018 Feb 3. [QxMD MEDLINE Link].
Younis I, Sarwar S, Butt Z, Tanveer S, Qaadir A, Jadoon NA. Clinical characteristics, predictors, and survival among patients with hepatopulmonary syndrome. Ann Hepatol. 2015 May-Jun. 14 (3):354-60. [QxMD MEDLINE Link].
Kitis G, Thompson H, Allan RN. Finger clubbing in inflammatory bowel disease: its prevalence and pathogenesis. Br Med J. 1979 Oct 6. 2(6194):825-8. [QxMD MEDLINE Link].
Barraud-Klenovsek MM, Lübbe J, Burg G. Primary digital clubbing associated with palmoplantar keratoderma. Dermatology. 1997. 194(3):302-5. [QxMD MEDLINE Link].
Mullins GM, Lenhard RE Jr. Digital clubbing in Hodgkin's disease. Johns Hopkins Med J. 1971 Mar. 128(3):153-7. [QxMD MEDLINE Link].
Dispenzieri A, Gertz MA. Treatment options for POEMS syndrome. Expert Opin Pharmacother. 2005 Jun. 6(6):945-53. [QxMD MEDLINE Link].
Miest RY, Comfere NI, Dispenzieri A, Lohse CM, El-Azhary RA. Cutaneous manifestations in patients with POEMS syndrome. Int J Dermatol. 2013 Apr 4. [QxMD MEDLINE Link].
Grekas D, Avdelidou A. Digital clubbing as an unusual complication associated with severe secondary hyperparathyroidism: report of two cases. Hemodial Int. 2007 Apr. 11(2):193-7. [QxMD MEDLINE Link].
Helvaci MR, Gokce C, Davran R, Acipayam C, Akkucuk S, Ugur M. Tonsilectomy in sickle cell diseases. Int J Clin Exp Med. 2015. 8 (3):4586-90. [QxMD MEDLINE Link].
Schuller A, Cottin V, Hot A, Cordier JF. Finger clubbing and altered carbon monoxide transfer capacity in cannabis smokers. Eur Respir J. 2008 Feb. 31(2):473-4. [QxMD MEDLINE Link].
El Bakkal A, Idrissi R, Meziane M, Mikou O, Sekal M, Belghiti H, et al. [Tripe palms and a hypertrophic osteoarthropathy syndrome revealing a neuroendocrine carcinoma of the lung]. Ann Dermatol Venereol. 2011 Oct. 138(10):668-72. [QxMD MEDLINE Link].
Katsurada N, Tachihara M, Jimbo N, Koyama K, Nakata K, Nagano T, et al. Successful Treatment of ROS1-rearranged Lung Cancer Complicated by Hypertrophic Pulmonary Osteoarthropathy with Crizotinib Therapy: A Case Report. Intern Med. 2019 Jan 10. [QxMD MEDLINE Link].
Thompson MA, Warner NB, Hwu WJ. Hypertrophic osteoarthropathy associated with metastatic melanoma. Melanoma Res. 2005 Dec. 15(6):559-61. [QxMD MEDLINE Link].
Malaty S, Gupta A. Hypertrophic Osteoarthropathy: A Secondary Manifestation of Malignant Melanoma. Case Rep Rheumatol. 2021. 2021:6691320. [QxMD MEDLINE Link].
Lommatzsch M, Julius P, Lück W, Bier A, Virchow JC. [Hypertrophic Pulmonary Osteoarthropathy as a Cue for NSCLC: Four Cases in the Light of the Current Literature]. Pneumologie. 2012 Feb. 66(2):67-73. [QxMD MEDLINE Link].
Essouma M, Nkeck JR, Agbor VN, Noubiap JJ. Epidemiology of Digital Clubbing and Hypertrophic Osteoarthropathy: A Systematic Review and Meta-analysis. J Clin Rheumatol. 2022 Mar 1. 28 (2):104-110. [QxMD MEDLINE Link].
Tajbakhsh R, Dehghan M, Azarhoosh R, Haghighi AN, Sadani S, Zadeh SS, et al. Mucocutaneous manifestations and nail changes in patients with end-stage renal disease on hemodialysis. Saudi J Kidney Dis Transpl. 2013 Jan. 24(1):36-40. [QxMD MEDLINE Link].
Salem A, Al Mokadem S, Attwa E, Abd El Raoof S, Ebrahim HM, Faheem KT. Nail changes in chronic renal failure patients under haemodialysis. J Eur Acad Dermatol Venereol. 2008 Nov. 22(11):1326-31. [QxMD MEDLINE Link].
Ddungu H, Johnson JL, Smieja M, Mayanja-Kizza H. Digital clubbing in tuberculosis--relationship to HIV infection, extent of disease and hypoalbuminemia. BMC Infect Dis. 2006 Mar 10. 6:45. [QxMD MEDLINE Link].
Saigal R, Kansal A, Mittal M, Singh Y, Ram H. Pachydermoperiostosis with myelofibrosis and empty sella. J Assoc Physicians India. 2010 Apr. 58:253-5. [QxMD MEDLINE Link].
Kinjo T, Arakaki W, Fujita J. Unilateral digital clubbing in hemiplegia due to a putaminal hemorrhage. Clin Case Rep. 2022 Mar. 10 (3):e05519. [QxMD MEDLINE Link]. [Full Text].
Ozdemir B, Senturk T, Kaderli AA, et al. Postoperative regression of clubbing at an unexpected rate in a patient with aortic and mitral valve replacement due to infective endocarditis. Ir J Med Sci. 2008 Oct 9. [QxMD MEDLINE Link].
Moralidis E, Gerasimou G, Theodoridou A, Hilidis I, Mylonaki E, Gotzamani-Psarrakou A. Hypertrophic osteoarthropathy manifested with isolated calcaneal periostitis in bone scintigraphy. Ann Nucl Med. 2010 Feb 2. [QxMD MEDLINE Link].
Pinto-Almeida T, Caetano M, Alves R, Selores M. Cutaneous lesions and finger clubbing uncovering hypocomplementemic urticarial vasculitis and hepatitis C with mixed cryoglobulinemia. An Bras Dermatol. 2013 Nov-Dec. 88(6):973-6. [QxMD MEDLINE Link]. [Full Text].
Gefen AM, White AJ. Asymptomatic pulmonary arteriovenous malformations in children with hereditary hemorrhagic telangiectasia. Pediatr Pulmonol. 2017 Jun 13. [QxMD MEDLINE Link].
Rush PJ, Giorshev C, Shore A, Levinson H. The use of thermography in clubbing. Respir Med. 1992 May. 86(3):257-9. [QxMD MEDLINE Link].
Ward RW, Chin R Jr, Keyes JW Jr, Haponik EF. Digital clubbing. Demonstration with positron emission tomography. Chest. 1995 Apr. 107(4):1172-3. [QxMD MEDLINE Link].
Roy HS, Wang Z, Ran H, Song W, Zheng Y. Diagnosis of digital clubbing by high-frequency ultrasound imaging. Int J Dermatol. 2013 Jan. 52(1):1-5. [QxMD MEDLINE Link].
Adams B, Amin T, Leone V, Wood M, Kraft JK. Primary hypertrophic osteoarthropathy: ultrasound and MRI findings. Pediatr Radiol. 2016 May. 46 (5):727-30. [QxMD MEDLINE Link].

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Clubbed fingernail.

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Author

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Professor of Pediatrics, Professor of Medicine, Rutgers New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, New York Academy of Medicine, Royal College of Physicians of Edinburgh, Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Coauthor(s)

Gregory M Richards, MD Clinical Assistant Professor, Department of Human Oncology, University of Wisconsin School of Medicine and Public Health

Gregory M Richards, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Radiology, American Medical Association, American Roentgen Ray Society, American Society for Radiation Oncology, Radiological Society of North America, American Society of Clinical Oncology

Disclosure: Nothing to disclose.

Supriya Goyal, MD Consulting Dermatologist

Supriya Goyal, MD is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Former Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Military Dermatologists, Phi Beta Kappa, Texas Dermatological Society

Disclosure: Nothing to disclose.

Warren R Heymann, MD Head, Division of Dermatology, Professor, Department of Internal Medicine, Rutgers New Jersey Medical School

Warren R Heymann, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD<br/>Served as a speaker for various universities, dermatology societies, and dermatology departments.

Additional Contributors

Richard K Scher, MD Adjunct Professor of Dermatology, University of North Carolina at Chapel Hill School of Medicine; Professor Emeritus of Dermatology, Columbia University College of Physicians and Surgeons

Richard K Scher, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, American Medical Association, The Society of Federal Health Professionals (AMSUS), International Society for Dermatologic Surgery, Noah Worcester Dermatological Society, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Clubbing of the Nails Clinical Presentation

History

Complications

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