NAIL CLUBBING

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Nail clubbing (also known as "Drumstick fingers," "Hippocratic fingers," and "Watch-glass nails") is a deformity of the fingers and fingernails that is associated with a number of diseases, mostly of the heart and lungs. Clubbing develops in five steps:

1 Fluctuation and softening of the nail bed (increased ballotability) 2 Loss of the normal <165° angle (Lovibond angle) between the nailbed and the fold (cuticula) 3 Increased convexity of the nail fold 4Thickening of the whole distal (end part of the) finger (resembling a drumstick) 5Shiny aspect and striation of the nail and skin

Schamroth's test or Schamroth's window test is a popular test for clubbing. When the distal phalanges (bones nearest the fingertips) of corresponding fingers of opposite hands are directly opposed (place fingernails of same finger on opposite hands against each other, nail to nail), a small diamond-shaped "window" is normally apparent between the nailbeds. If this window is obliterated, the test is positive and clubbing is present.

Clubbing is associated with:

Lung disease:

Lung cancer, mainly non-small cell (54% of all cases), not seen frequently in small cell lung cancer (< 5% of cases) Interstitial lung disease Tuberculosis Suppurative lung disease: lung abscess, empyema, bronchiectasis, cystic fibrosis Pleural Mesothelioma A·V fistula

Heart disease:

Any disease featuring chronic hypoxia Congenital cyanotic heart disease (most common cardiac cause) Subacute bacterial endocarditis Atrial myxoma (benign tumor) Gastrointestinal and hepatobiliary: Malabsorption Crohn's disease and ulcerative colitis Cirrhosis, especially in primary biliary cirrhosis Hepatopulmonary syndrome, a complication of cirrhosis Laxative abuse Polyposis Esophageal CA Others: Hyperthyroidism (thyroid acropachy) Familial and racial clubbing and "pseudoclubbing" (people of African descent often have what appears to be clubbing) Vascular anomalies of the affected arm such as an axillary artery aneurysm (in unilateral clubbing) Thymoma