Clubbed Fingers

From Anvita Health Wiki

Contents 1 Introduction 2 Etiology 3 Pathology 4 Clinical-manifestations 5 More General Terms 6 Additional Terms 7 References

Introduction

• Bulbous enlargement & broadening of the fingertips.

Etiology

• idiopathic inherited autosomal dominant trait
• any disease associated with chronic hypoxia
• cardiac disease

• cyanotic heart disease
• bacterial endocarditis
• artial myxoma

• pulmonary disease

• primary & metastatic cancer (35% large cell carcinoma)
• bronchiectasis
• lung abscess, empyema
• mesothelioma
• tuberculosis
• cystic fibrosis
• pulmonary hypertension
• pulmonary arteriovenous shunt - emphysema
• hypertrophic pulmonary osteoarthropathy

• gastrointestinal disease

• inflammatory bowel disease

• ulcerative colitis
• Crohn's disease

• hepatic cirrhosis
• malabsorption

• others

• hyperthyroidism
• vascular anomalies of the affected arm
  

• C: cyanotic heart disease
• L: lung cancer, lung abscess, lung fibrosis, lung AV malformation
• U: ulcerative colitis
• B: bronchiectasis
• B: benign mesothelioma
• I: infective endocarditis
• N: neurogenic tumors
• G: gastrointestinal diseases, i.e. cirrhosis, regional enteritis
  

Pathology

• hyperplasia of the fibrovascular tissue between the nail matrix & the bony phalynx
• increased blood supply to the fingers
• may be a result of humoral vasodilator
• platelet precursors fail to fragment into platelets in pulmonary circulation
• platelet precursors become trapped in peripheral vasculature releasing PDGF, VEGF, increased vascularity [4]

Clinical-manifestations

• thickening & widening of the distal end of the digits, fingers & toes
• increased convexity of the nail fold [8] <picture>
• the angle made by the proximal nail fold & the nail plate ( Lovibond's angle) exceeds 180 degrees
• the tissue between the nail plate & the underlying bone has a spongy quality
• cyanosis is present with cyanotic heart disease & some forms of pulmonary disease

More General Terms

• sign/symptom
• nail disease

Additional Terms

• bronchiectasis
• cirrhosis
• Crohn's disease (terminal ileitis, regional enteritis, granulomatous enteritis, chronic cicatrizing enteritis)
• endocarditis
• Lovibond's angle
• lung cancer
• nail fold (paronychium)
• nail matrix
• nail plate
• ulcerative colitis

References

1. Color Atlas & Synopsis of Clinical Dermatology, Common & Serious Diseases, 3rd ed, Fitzpatrick et al, McGraw Hill, NY, 1997, pg 502
2. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 720
3. Harrison's Principles of Internal Medicine, 13th ed. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1994, pg 183
4. Spicknall KE et al, Clubbing: an updated on diagosis, differential diagnosis, pathophysiology and clinical relevance J Am Acad Dermatol 2005; 52:1020 PMID: [1]
5. Myers KA, Farquhar DR. The rational clinical examination: does this patient have clubbing? JAMA. 2001;286:341-7. PMID: [2]
6. Sridhar KS, Lobo CF, Altman RD. Digital clubbing and lung cancer. Chest 1998;114:1535-37. PMID: [3]
7. Naeije R. Hepatopulmonary syndrome and portopulmonary hypertension. Swiss Med Wkly. 2003;133:163-9. PMID: [4]
8. Clubbing, Wikipedia (accessed 06/26/06) <picture> [5]

clubbed fingers; clubbing (Hippocratic fingers)