Clubbing of the fingers or toes

Definition

Clubbing is a thickening of the flesh under the toenails and fingernails. The nail curves downward, similar to the shape of the round part of an upside-down spoon.

Alternative Names

Clubbing

Considerations

Clubbing occurs with a wide number of diseases. It is most often found in heart and lung diseases that cause a lower-than-normal amount of oxygen in the blood.

Clubbing may also be due to lung cancer, and diseases of the liver and gastrointestinal tract.

Clubbing may also occur in families. In this case it may not be due to an underlying disease.

Common Causes

• Chronic lung conditions
  • Bronchiectasis
  • Cystic fibrosis
  • Lung abscess
  • Lung cancer
  • Pulmonary fibrosis
• Congenital heart disease (cyanotic type)
  • Tetralogy of Fallot
  • Total anomalous venous return
  • Transposition of the great vessels
  • Tricuspid atresia
  • Truncus arteriosus
• Digestive system diseases
  • Celiac disease
  • Cirrhosis
  • Crohn's disease and ulcerative colitis
• Graves disease or hyperthyroidism
• Other conditions
  • Dysentery
  • Other types of cancer, including liver, gastrointestinal, Hodgkin's lymphoma
  • Subacute endocarditis
  • Tuberculosis of the intestines

Home Care

There is no specific treatment for the clubbing itself. Home care depends on the diagnosis.

Call your health care provider if

If you notice clubbing, call your health care provider.

What to expect at your health care provider's office

A person with clubbing usually has other symptoms and signs of a specific condition. Diagnosing that condition is based on:

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

Medical history questions may include:

• Do you have any breathing difficulty?
• Does clubbing affect the fingers, toes, or both?
• Is it becoming more noticeable?
• Is the skin ever bluish-colored?
• What other symptoms do you have?
• When did you first notice this?

The following tests may be done:

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

References

Fitzgerald FT, Murray JF. History and physical examinations. In: Mason RJ, Murray JF, Broaddus CV, Nadel JA, eds. Murray & Nadel's Textbook of Respiratory Medicine. 4th ed. Philadelphia, Pa: Saunders Elsevier;2005:chap 18.

Spicknall KE. Clubbing: an update on diagnosis, differential diagnosis, pathophysiology, and clinical relevance. J Am Acad Dermatol. 2005;52:1020-1028.