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Clubbing of the fingers or toes

Clubbing

 

Clubbing is changes in the areas under and around the toenails and fingernails that occur with some disorders. The nails also show changes.

Considerations

 

Common symptoms of clubbing:

  • The nail beds soften. The nails may seem to "float" instead of being firmly attached.
  • The nails forms a sharper angle with the cuticle.
  • The last part of the finger may appear large or bulging. It may also be warm and red.
  • The nail curves downward so it looks like the round part of an upside-down spoon.

Clubbing can develop quickly, often within weeks. It also can go away quickly when its cause is treated.

 

Causes

 

Lung cancer is the most common cause of clubbing. Clubbing often occurs in heart and lung diseases that reduce the amount of oxygen in the blood. These may include:

  • Heart defects that are present at birth (congenital)
  • Chronic lung infections that occur in people with bronchiectasis, cystic fibrosis, or lung abscess
  • Infection of the lining of the heart chambers and heart valves (infectious endocarditis). This can be caused by bacteria, fungi, or other infectious substances
  • Lung disorders in which the deep lung tissues become swollen and then scarred (interstitial lung disease)

Other causes of clubbing:

  • Celiac disease
  • Cirrhosis of the liver and other liver diseases
  • Dysentery
  • Graves disease
  • Overactive thyroid gland
  • Other types of cancer, including liver, gastrointestinal, Hodgkin lymphoma

 

When to Contact a Medical Professional

 

If you notice clubbing, call your health care provider.

 

What to Expect at Your Office Visit

 

A person with clubbing often has symptoms of another condition. Diagnosing that condition is based on:

  • Family history
  • Medical history
  • Physical exam that looks at the lungs and chest

The provider may ask questions such as:

  • Do you have any trouble breathing?
  • Do you have clubbing of the fingers, toes, or both?
  • When did you first notice this? Do you think it is getting worse?
  • Does the skin ever have a blue color?
  • What other symptoms do you have?

The following tests may be done:

  • Arterial blood gas
  • Chest CT scan
  • Chest x-ray
  • Echocardiogram
  • EKG
  • Pulmonary function tests

There is no treatment for the clubbing itself. The cause of clubbing can be treated, however.

 

 

References

Davis JL, Murray JF. History and physical examinations. In: Broaddus VC, Mason RJ, Ernst MD, et al. Murray & Nadel's Textbook of Respiratory Medicine. 6th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 16.

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        Tests for Clubbing of the fingers or toes

         
           

          Review Date: 4/21/2015

          Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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