Clubbing

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

Measurement

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

Examination

  • 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)

Causes

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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