Nail clubbing is a finger deformity where the tip of the finger swells and the angle between the nail bed and the nail is lost. It can be a sign of heart, inflammatory bowel, or lung disease and is associated with increased blood flow to the fingertips. The condition can also affect the feet.
Nail clubbing is a deformity of the fingers in which the tip of the finger swells and the angle between the nail bed and the nail is lost. It occurs most often on the fingers of both hands and is usually not associated with pain. Nail clubbing can be a sign of heart disease, inflammatory bowel disease, or lung disease, and is also seen in a number of other conditions. It can also be referred to as wand fingers, hippocratic fingers, watch glass nails, or just plain clubbing. The condition was first described by Hippocrates of ancient Greece, who is sometimes called the founder of modern medicine.
Normally, when people without nail clubs bring the ends of their opposite toes together so that their nails rest against each other, a diamond-shaped space is seen between them. In people with clubbing, the loss of the angle between the nail and its bed causes this space to disappear. This is referred to as the Schamroth window test. When the angle between the nail and its bed is greater than 180 degrees, the nail is definitely present. Angles approaching 180 degrees could be an early stage in clubbing.
In a patient with clubbing, the nails may feel less hard than usual when pressed. This is due to an increase in the underlying soft tissue. While the exact cause of clubbing is not understood, it is known that blood flow to the fingertips is greater than usual. This is thought to cause the tissue changes seen under the nail beds. Nail clubbing that occurs in association with disease is known as secondary clubbing, and primary clubbing, which occurs without disease, is rare.
When nail clubbing is seen in association with a heart defect, the clubbing sometimes improves when the problem is surgically corrected. Clubbing is mainly associated with heart structure abnormalities present from birth, although it is also seen in bacterial infections of the heart. Nail clubbing occurs in many respiratory diseases and can be present in up to 29% of lung cancer patients. When a patient with clubbing does not appear to show any signs of disease, doctors should investigate carefully in case there is a hidden problem such as lung cancer. Clubbing can also affect the feet, although it can be more difficult to recognize due to the naturally more rounded shape of the toes.
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