FINGER CLUBBING It is a bulbous enlargement of soft parts of the terminal phalanges with both transverse and longitudinal curving of the nails. The swelling of the terminal phalanges in clubbing occurs due to interstitial edema and dilation of the arterioles and capillaries. CLUBBING is mostly asymptomatic, but may predict the presence of some dreaded underlying diseases. Clubbing was first described by Hippocrates nearly 2500 years ago in & is regarded to be the oldest sign in clinical medicine. Digital clubbing may occur as isolated finding or is often part of the syndrome of hypertrophic osteoarthropathy. GRADES OF CLUBBING I.. Fluctuation and softening of the nail bed. II. Loss of the normal <165° angle between the nailbed and the fold. III.. Increased convexity of the nail fold IV.. Thickening of the whole distal  finger (resembling a drumstick) The process usually takes years but in certain conditions like lung abscess, empyema of thorax, clubbing may develop quite fast. Grading of clubbing has no clinical significance. MECHANISM OF CLUBBING The exact MECHANISM is not known. But most acceptable hypothesis is… megakaryocyte or platelet clusters, lodged in the peripheral vessels of the digits, release platelet-derived growth factor or vascular endothelial growth factor to cause dilatation of vessels and lead to the increased vascularity, permeability, and connective tissue changes that are the hallmark of clubbing. CAUSES OF DIGITAL CLUBBING PULMONARY Bronchogenic carcinoma Lung abscess, Empyema Bronchiectasis Tuberculois with secondary infections Cystic fibrosis Diffuse fibrosing alveolitis CARDIAC Infective endocarditis Cyanotic heart disease Congenital heart disease GASTROINTESTINAL Ulcerative colitis Crohn’s disease Cholangiolitic cirrhosis Inflmmatory Bowel Disease ENDOCRINE Iatrogenic myxedema Exophthalmosis Acromegaly Miscellaneous Causes HEREDITARY Idiopathic UNILATERAL CLUBBING Pancoast tumor, subclavian and innominate artery aneurysm UNIDIGITAL CLUBBING Traumatic or gout deposit In heroin addicts due to chronic obstructive phlebitis DIFFERENTIAL CLUBBING clubbing may occur in lower limbs, sparing the upper limbs. It may occur in patient with patent ductus arteriosus with right to left shunt. CLUBBING CAUSES… EASY MNEMONIC CLUBBING C.. Cyanotic heart disease L.. Lung disease (hypoxia, lung cancer, bronchiectasis, cystic fibrosis) U.. Ulcerative Colitis /Crohn's disease B.. Biliary cirrhosis B.. Birth defect (harmless) I.. Infective endocarditis N.. Neoplasm (esp. Hodgkins) G.. GI malabsorption I hope this piece of information will be useful to most of us Dr K N Poddar

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very very useful post very very important signs for clinicians which can aid and give important clue regarding no. of critical illnesses inturn referance will be earlier which inturn benefit the patients. Sir sincere thanks for posting such important topic. please continue educating us

Wonderful post Dr Poddar sir

Very nice & informative.

Wonderful post on CLUBBING & IT'S CAUSES. Keep continuing sir. A very good job.

Nice post sir

Thank you sir , its helpful

very nice post sir. . Thanks.

Very useful and interesting information with nice presentation

very nice and very useful post

Nice information with classification

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