Clubbing of the fingers or toes
ClubbingClubbing is changes in the areas under and around the toenails and fingernails that occur with some disorders. The nails may also show changes.
Considerations
Common symptoms of clubbing:
- The nail beds soften. The nails may seem to "float" instead of being firmly attached.
- The nails form a sharper angle with the cuticle.
- The last part of the finger may appear large or bulging. It may also be warm and red.
- The nail curves downward so it looks like the round part of an upside-down spoon.
Clubbing can develop quickly, often within weeks. It also can go away quickly when its cause is treated.
Causes
Lung cancer is the most common cause of clubbing. Clubbing often occurs in heart and lung diseases that reduce the amount of oxygen in the blood. These may include:
Lung cancer
Lung cancer is cancer that starts in the lungs. The lungs are located in the chest. When you breathe, air goes through your nose, down your windpipe...
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Heart defects that are present at birth (congenital)
Heart defects that are present at birth
Cyanotic heart disease refers to a group of many different heart defects that are present at birth (congenital). They result in a low blood oxygen l...
Read Article Now Book Mark Article - Chronic lung infections that occur in people with bronchiectasis, cystic fibrosis, or lung abscess
Bronchiectasis
Bronchiectasis is a disease in which the large airways in the lungs are damaged. This causes the airways to become permanently wider. Bronchiectasis...
Read Article Now Book Mark ArticleCystic fibrosis
Cystic fibrosis is a disease that causes thick, sticky mucus to build up in the lungs, digestive tract, and other areas of the body. It is one of th...
Read Article Now Book Mark ArticleAbscess
An abscess is a collection of pus in any part of the body. In most cases, the area around an abscess is swollen and inflamed.
Read Article Now Book Mark Article - Infection of the lining of the heart chambers and heart valves (infectious endocarditis). This can be caused by bacteria, fungi, or other infectious substances
- Lung disorders in which the deep lung tissues become swollen and then scarred (interstitial lung disease)
Interstitial lung disease
Interstitial lung disease (ILD) is a group of lung disorders in which the lung tissues become inflamed and then damaged.
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Other causes of clubbing:
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Celiac disease
Celiac disease
Celiac disease is an autoimmune condition that damages the lining of the small intestine. This damage comes from a reaction to eating gluten. This ...
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Cirrhosis of the liver and other liver diseases
Cirrhosis
Cirrhosis is scarring of the liver and poor liver function. It is the last stage of chronic liver disease.
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Graves disease
Graves disease
Graves disease is an autoimmune disorder that leads to an overactive thyroid gland (hyperthyroidism). An autoimmune disorder is a condition that occ...
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- Other types of cancer, including liver, gastrointestinal, Hodgkin lymphoma
Hodgkin lymphoma
Hodgkin lymphoma is a cancer of lymph tissue. Lymph tissue is found in the lymph nodes, spleen, liver, bone marrow, and other sites.
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When to Contact a Medical Professional
If you notice clubbing, contact your health care provider.
What to Expect at Your Office Visit
A person with clubbing often has symptoms of another condition. Diagnosing that condition is based on:
- Family history
- Medical history
- Physical exam that looks at the lungs and chest
The provider may ask questions such as:
- Do you have any trouble breathing?
- Do you have clubbing of the fingers, toes, or both?
- When did you first notice this? Do you think it is getting worse?
- Does the skin ever have a blue color?
- What other symptoms do you have?
The following tests may be done:
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Arterial blood gas
Arterial blood gas
Blood gases are a measurement of how much oxygen and carbon dioxide are in your blood. They also determine the acidity (pH) of your blood.
Read Article Now Book Mark Article - Chest CT scan
CT scan
A computed tomography (CT) scan is an imaging method that uses x-rays to create pictures of cross-sections of the body. Related tests include:Abdomin...
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Chest x-ray
Chest x-ray
A chest x-ray is an x-ray of the chest, lungs, heart, large arteries, ribs, and diaphragm.
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Echocardiogram
Echocardiogram
An echocardiogram is a test that uses sound waves to create pictures of the heart. The picture and information it produces is more detailed than a s...
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Electrocardiogram (ECG)
Electrocardiogram (ECG)
An electrocardiogram (ECG) is a test that records the electrical activity of the heart.
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Pulmonary function tests
Pulmonary function tests
Pulmonary function tests are a group of tests that measure breathing and how well the lungs are functioning.
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There is no treatment for the clubbing itself. The cause of clubbing can be treated, however.
References
Drake WM, Chowdhury TA. General patient examination and differential diagnosis. In: Glynn M, Drake WM, eds. Hutchison's Clinical Methods. 25th ed. Philadelphia, PA: Elsevier; 2023:chap 2.
Fajardo E, Davis JL. History and physical examination. In: Broaddus VC, Ernst JD, King TE, Lazarus SC, Sarmiento KF, Schnapp LM, Stapleton RD, eds. Murray and Nadel's Textbook of Respiratory Medicine. 7th ed. Philadelphia, PA: Elsevier; 2022:chap 18.
Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM. Cyanotic congenital heart lesions: lesions associated with decreased pulmonary blood flow. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 457.
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Clubbing - illustration
Clubbing may result from chronic low blood-oxygen levels. This can be seen with cystic fibrosis, congenital cyanotic heart disease, and several other diseases. The tips of the fingers enlarge and the nails become extremely curved from front to back.
Clubbing
illustration
-
Clubbed fingers - illustration
Clubbed fingers is a symptom of disease, often of the heart or lungs which cause chronically low blood levels of oxygen. Diseases which cause malabsorption, such as cystic fibrosis or celiac disease can also cause clubbing.
Clubbed fingers
illustration
-
Clubbing - illustration
Clubbing may result from chronic low blood-oxygen levels. This can be seen with cystic fibrosis, congenital cyanotic heart disease, and several other diseases. The tips of the fingers enlarge and the nails become extremely curved from front to back.
Clubbing
illustration
-
Clubbed fingers - illustration
Clubbed fingers is a symptom of disease, often of the heart or lungs which cause chronically low blood levels of oxygen. Diseases which cause malabsorption, such as cystic fibrosis or celiac disease can also cause clubbing.
Clubbed fingers
illustration
Review Date: 4/25/2023
Reviewed By: Charles I. Schwartz, MD, FAAP, Clinical Assistant Professor of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, General Pediatrician at PennCare for Kids, Phoenixville, PA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.