Digital clubbing: What it is, definition, symptoms, causes, diagnosis and treatments

Digital clubbing is a change in the structure of the nails or feet where the finger and nail take on the appearance of an upside-down spoon, becoming red and sponge-like.

It can occur alone or with other symptoms, such as shortness of breath or coughing.

There are several possible causes, including lung disease, heart disease, and digestive tract problems.

Although about 90% of cases are related to lung cancer.

It can also be an inherited normal trait. The diagnosis is made primarily through observation of the fingers.

Usually the medical alert should order other studies such as a chest CT scan and more.

Treatment will depend on the underlying cause of clubbing .

Symptoms

Finger clubbing is a medical condition first described by Hippocrates in which the fingers (and/or toes) have the appearance of upside-down spoons.

It is caused by a buildup of tissue on the far part of the fingers (terminal phalanges), which causes the fingertips to become dilated and the nails to curve downwards.

In addition to a change in the angle of the nail and nail bed, the nails may become spongy and soft, and show a reddish discoloration.

The “growth” in the digits appears to occur both laterally; from side to side and lengthwise; lengthwise along the fingers.

Disco most often happens gradually, but it can happen quickly for some people.

For people with secondary clubbing , the symptom may go away after successful treatment of the underlying cause.

Causes

While many doctors think of lung causes first when they encounter people with clubbing , there are a number of potential causes.

They fall into a few categories:

Idiopathic:

This is a category where it occurs for no apparent reason and is of no medical concern it simply is.

Inherited trait:

There are a few ways to inherit the disease.

Most of the time, the trait is inherited in an autosomal dominant fashion, which means that if one of your parents is a carrier of the trait, there is a 50:50 chance that you will also inherit the trait.

Secondary digital clubbing:

Secondary clubbing occurs in association with a medical condition. Conditions commonly associated with nightclubs include:

Lung cancer:

It is a sign found in about 29% of people with lung cancer and is the most common cause of digital clubbing (accounting for about 90% of cases).

It is much more common with non-small cell lung cancer than with small cell lung cancer.

Other cancers:

Other cancers, especially Hodgkin’s disease, may be present with clubbing .

Lung diseases:

Some lung diseases associated with digital clubbing include bronchiectasis, interstitial lung diseases such as idiopathic pulmonary fibrosis, empyema, pulmonary tuberculosis, and cystic fibrosis.

Congenital heart disease:

Heart disease that is present from birth, especially “cyanotic heart disease” like tetralogy of Fallot, often accompanied by clubbing .

Gastrointestinal diseases:

Some diseases in this category associated with clubbing include celiac sprue, cirrhosis, Crohn’s disease, and ulcerative colitis.

Endocrine problems:

Hyperthyroidism , especially Grave ‘s disease, may be accompanied by clubbing . The process underlying digital clubbing is not yet understood.

Scientists think it may be related to platelet-derived growth factor and vascular endothelial growth factor, although the precise mechanism is not known.

No one is quite sure why it occurs, and there are likely several mechanisms. Dilation of blood vessels in the regions away from the fingers results in the formation of connective tissue.

Leading to the onset of clubbing , but there are likely many different reasons for this to happen, stay tuned and don’t miss out on the symptoms, they are important.

Diagnosis

Most of the time, clubbing is seen on a physical exam and is expected based on other findings (such as the presence of lung disease or cancer).

It is often obvious, but when subtle, other findings and measurements can be done to confirm the diagnosis. These include:

Lovibond Angle: The angle between the base of the nail and the nail itself distal/interphalangeal depth ratio

Schamroth’s sign: Lack of a window (gap) between the fingers when the digits of each hand are placed together with the tops of both hands touching.

Differential diagnosis: Some rheumatoid diseases, such as reactive arthritis (Reiter’s syndrome), can mimic the appearance of clubbing .

Diagnostic tests for causes of clubbing:

If your doctor notices that you have clubbing, or if you raise this concern to your doctor, the first thing he or she will do is ask about your family history to determine if it could be a hereditary trait.

The doctor will then take a careful history and physical examination, keeping in mind possible causes associated with secondary clubbing .

Some tests, depending on your symptoms, may include:

• A CT scan of your chest and/or other studies to look for lung cancer, as well as other lung and heart conditions
• An electrocardiogram (EKG) and/or echocardiogram to assess your heart
• Arterial blood gases and/or lung function tests to assess your lung function and look for underlying lung disease
• Blood tests, such as liver function tests and thyroid function tests.

Treatment

There is no specific treatment, including surgical procedures for clubbing .

Treating the underlying cause of clubbing may result in resolution for some people.

For example, in people with heart valve defects, clubbing may disappear after successful surgery.

So treatment will vary greatly depending on your underlying cause.