This is the swelling go the terminal part of fingers and toes

It happens due to hypertrophy of the soft tissue in nail bed causing an increase in the anterior-posterior and transverse diameter of the nail


It is measured by measuring the angle between the nail and nail bed  – Its called the Lovibond angle


  • Ask the patient to hold their index finger extended and look at it by bringing it to your eye level
  • Press the nail bed to look for fluctuation
  • Now place the nails of the two fingers of the two hands against each other such that the nails are facing each other
  • Always use the  corresponding fingers to examine That means both the index fingers or thumbs against each other
  • Look for the space between the nail. Normally it should be a diamond shaped.
  • In clubbing, it becomes obliterated
  • This is called the ‘Schamroths sign’

The normal is usually 160 degrees

Degrees of clubbing

  1. First degree
    • Increased fluctuation
  2. Second degree
    • Nails become smooth glossy along with the increased fluctuation
  3. Third degree
    • Second degree with an increase in pulp tissue
  4. Fourth grade
    • Third degree with wrist and ankle swelling(Hypertrophic osteoarthropathy)


Cardiac conditions

  • Congenital cyanotic heart disease
  • Subacute bacterial endocarditis
  • Eisenmenger syndrome

Respiratory causes

  • Cystic fibrosis
  • Bronchiectasis
  • Empyema

Gastrointestinal/ Hepatic causes

  • Ulcerative colitis
  • Biliary cirrhosis
  • Malabsorption syndrome
  • Crohns syndrome
  • Coeliac disease

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