Clubbing: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
No edit summary
Line 98: Line 98:
(In alphabetical order)
(In alphabetical order)
* [[achalasia]]
* [[achalasia]]
* Arteriovenous malformations
* [[Arteriovenous malformation]]s
* Arterial vascular [[prosthesis]] infections  
* Arterial vascular [[prosthesis]] infections  
* [[Atrial myxoma]]
* [[Atrial myxoma]]
* Bronchial carcinomas
* Bronchial carcinomas
* [[Bronchiectasis]]
* [[Bronchiectasis]]
* [[Cannabis]] <ref name="pmid18238953">{{cite journal |author=Schuller A, Cottin V, Hot A, Cordier JF |title=Finger clubbing and altered carbon monoxide transfer capacity in cannabis smokers |journal=Eur. Respir. J. |volume=31 |issue=2 |pages=473–4 |year=2008 |month=February |pmid=18238953 |doi=10.1183/09031936.00150907 |url=}}</ref>
* [[Celiac Sprue]]
* [[Celiac Sprue]]
* [[Cerebrovascular insult]]
* [[Cerebrovascular insult]]
* Chronic obstructive [[jaundice]]
* Chronic obstructive [[jaundice]]
* [[Cirrhosis]]
* [[Cirrhosis]]
* Cyanotic [[congenital heart disease]]
* Cyanotic [[congenital heart disease]]<ref name="pmid3909407">{{cite journal |author=Pineda CJ, Guerra J, Weisman MH, Resnick D, Martinez-Lavin M |title=The skeletal manifestations of clubbing: a study in patients with cyanotic congenital heart disease and hypertrophic osteoarthropathy |journal=Semin. Arthritis Rheum. |volume=14 |issue=4 |pages=263–73 |year=1985 |month=May |pmid=3909407 |doi= |url=}}</ref>
**[[Tetralogy of Fallot]]  
**[[Tetralogy of Fallot]]  
**[[Total anomalous venous return]]  
**[[Total anomalous venous return]]  
Line 119: Line 120:
* [[Heart failure]]
* [[Heart failure]]
* [[Hepatoma]]
* [[Hepatoma]]
* [[Hodgkin's lymphoma]]
* [[Hodgkin's lymphoma]]<ref name="pmid5553121">{{cite journal |author=Mullins GM, Lenhard RE |title=Digital clubbing in Hodgkin's disease |journal=Johns Hopkins Med J |volume=128 |issue=3 |pages=153–7 |year=1971 |month=March |pmid=5553121 |doi= |url=}}</ref>
* [[Interstitial lung disease]]
* [[Interstitial lung disease]]
* [[Liver tumor]]s
* [[Liver tumor]]s
* [[Lung abscess]]
* [[Lung abscess]]
* [[metastatic melanoma]]<ref name="pmid16314744">{{cite journal |author=Thompson MA, Warner NB, Hwu WJ |title=Hypertrophic osteoarthropathy associated with metastatic melanoma |journal=Melanoma Res. |volume=15 |issue=6 |pages=559–61 |year=2005 |month=December |pmid=16314744 |doi= |url=}}</ref>
* [[Mesothelioma]]
* [[Mesothelioma]]
* [[Pachydermoperiostosis]]
* [[Pachydermoperiostosis]]
*[[POEMS]] [polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes]: a rare paraneoplastic syndrome secondary to a plasma cell dyscrasia in which clubbing may be seen. Other findings including peripheral neuropathy, organomegaly, endocrinopathy, monoclonal plasma proliferative disorder, skin changes, sclerotic bone lesions, Castleman disease, thrombocytosis, papilledema, peripheral edema, pleural effusions, ascites, and white nails.
* [[Primary biliray cirrhosis]]
* [[Primary biliray cirrhosis]]
* [[Pulmonic stenosis]]
* [[Pulmonic stenosis]]
* Pulmonary artery [[sarcoma]]  
* Pulmonary artery [[sarcoma]]<ref name="pmid8769527">{{cite journal |author=Loredo JS, Fedullo PF, Piovella F, Moser KM |title=Digital clubbing associated with pulmonary artery sarcoma |journal=Chest |volume=109 |issue=6 |pages=1651–3 |year=1996 |month=June |pmid=8769527 |doi= |url=}}</ref>
* [[Pulmonary fibrosis]]
* [[Pulmonary fibrosis]]
* Pulmonary metastases
* Pulmonary metastases
* Right-to-left [[cardiac shunt]]s
* Right-to-left [[cardiac shunt]]s
* [[sarcoidosis]] of the lungs
* [[sarcoidosis]] of the lungs <ref name="pmid">{{cite journal |author=West SG, Gilbreath RE, Lawless OJ |title=Painful clubbing and sarcoidosis |journal=JAMA |volume=246 |issue=12 |pages=1338–9 |year=1981 |month=September |pmid= |doi= |url=}}</ref>
* [[Silicosis]]
* [[Silicosis]]
* [[Thyroid cancer]]
* [[Thyrotoxicosis]]
* [[Thyrotoxicosis]]
* [[Tuberculosis]]
* [[Tuberculosis]]
Line 142: Line 146:
{|style="width:80%; height:100px" border="1"
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | Cyanotic congenital heart disease, right-to-left [[shunting]], [[bacterial [[endocarditis]], [[Tetralogy of Fallot]], [[Total anomalous venous return]], [[Transposition of the great vessels]], [[Tricuspid atresia]], [[Truncus arteriosus]]  
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | Cyanotic congenital heart disease, right-to-left [[shunting]], [[bacterial [[endocarditis]], [[Tetralogy of Fallot]], [[Total anomalous venous return]], [[Transposition of the great vessels]], [[Tricuspid atresia]], [[Truncus arteriosus]], [[arteriovenous malformation]]s , arterial vascular [[prosthesis]] infections, [[Atrial myxoma]]  
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
| '''Chemical / poisoning'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Cannabis]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
Line 154: Line 158:
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
| '''Drug Side Effect'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Cannabis]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
Line 170: Line 174:
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
| '''Gastroenterologic'''
|bgcolor="Beige"| [[ulcerative colitis]], [[Crohn disease]], [[primary biliary cirrhosis]], [[cirrhosis]] of the liver, [[leiomyoma]] of the esophagus, [[achalasia]], and [[peptic ulcer]] of the esophagus
|bgcolor="Beige"| [[ulcerative colitis]], [[Crohn disease]], [[primary biliary cirrhosis]], [[cirrhosis]] of the liver, [[leiomyoma]] of the esophagus, [[achalasia]], and [[peptic ulcer]] of the esophagus, [[Celiac Sprue]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Genetic'''
| '''Genetic'''
Line 182: Line 186:
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Cannabis]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
Line 206: Line 210:
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Thyroid cancer]], [[thymus cancer]], [[Hodgkin's disease]], [[POEMS]], [[metastatic melanoma]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
Line 222: Line 226:
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
| '''Pulmonary'''
|bgcolor="Beige"| [[lung cancer]], [[cystic fibrosis]], [[interstitial lung disease]], [[idiopathic pulmonary fibrosis]], [[ sarcoidosis]],[[lipoid pneumonia]], [[empyema]], [[pleural mesothelioma]], pulmonary artery [[sarcoma]], [[cryptogenic fibrosing alveolitis]],pulmonary metastases  
|bgcolor="Beige"| [[lung cancer]], [[cystic fibrosis]], [[interstitial lung disease]], [[idiopathic pulmonary fibrosis]], [[ sarcoidosis]],[[lipoid pneumonia]], [[empyema]], [[pleural mesothelioma]], pulmonary artery [[sarcoma]], [[cryptogenic fibrosing alveolitis]], pulmonary metastases, [[Bronchiectasis]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"

Revision as of 19:38, 26 May 2009

Clubbing
Clubbing in the fingers of a 33-year old female with pulmonary hypertension.
ICD-10 R68.3
ICD-9 781.5

WikiDoc Resources for Clubbing

Articles

Most recent articles on Clubbing

Most cited articles on Clubbing

Review articles on Clubbing

Articles on Clubbing in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Clubbing

Images of Clubbing

Photos of Clubbing

Podcasts & MP3s on Clubbing

Videos on Clubbing

Evidence Based Medicine

Cochrane Collaboration on Clubbing

Bandolier on Clubbing

TRIP on Clubbing

Clinical Trials

Ongoing Trials on Clubbing at Clinical Trials.gov

Trial results on Clubbing

Clinical Trials on Clubbing at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Clubbing

NICE Guidance on Clubbing

NHS PRODIGY Guidance

FDA on Clubbing

CDC on Clubbing

Books

Books on Clubbing

News

Clubbing in the news

Be alerted to news on Clubbing

News trends on Clubbing

Commentary

Blogs on Clubbing

Definitions

Definitions of Clubbing

Patient Resources / Community

Patient resources on Clubbing

Discussion groups on Clubbing

Patient Handouts on Clubbing

Directions to Hospitals Treating Clubbing

Risk calculators and risk factors for Clubbing

Healthcare Provider Resources

Symptoms of Clubbing

Causes & Risk Factors for Clubbing

Diagnostic studies for Clubbing

Treatment of Clubbing

Continuing Medical Education (CME)

CME Programs on Clubbing

International

Clubbing en Espanol

Clubbing en Francais

Business

Clubbing in the Marketplace

Patents on Clubbing

Experimental / Informatics

List of terms related to Clubbing

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Please Take Over This Page and Apply to be Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [2] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.

Overview

In medicine, clubbing, finger clubbing, or digital clubbing is a deformity of the fingers and fingernails that is associated with a number of diseases, mostly of the heart and lungs. Idiopathic clubbing can also occur. Hippocrates was probably the first to document clubbing as a sign of disease, and the phenomenon is therefore occasionally called Hippocratic fingers.

Epidemiology

The exact frequency of clubbing in the population is not known. A 2008 study found clubbing in 1% of all patients admitted to a department of internal medicine. Of these, 40% turned out to have significant underlying disease of various causes, while 60% had no medical problems on further investigations and remained well over the subsequent year.[1]

Pathophysiology

The exact cause for sporadic clubbing is unknown, and there are numerous theories as to its cause. Vasodilation (distended blood vessels), secretion of growth factors (such as platelet-derived growth factor and hepatocyte growth factor) from the lungs, and other mechanisms have been proposed. The discovery of disorders in the prostaglandin metabolism in primary osteo-arthropathy has led to suggestions that overproduction of PGE2 by other tissues may be the causative factor for clubbing.[2]

Diagnosis

Signs and symptoms

Clubbing develops in five steps:[3]

  1. Fluctuation and softening of the nail bed (increased ballotability)
  2. Loss of the normal <165° angle ("Lovibond angle") between the nailbed and the fold (cuticula)
  3. Increased convexity of the nail fold
  4. Thickening of the whole distal (end part of the) finger (resembling a drumstick)
  5. Shiny aspect and striation of the nail and skin

Schamroth's test or Schamroth's window test (originally demonstrated by South African cardiologist Dr Leo Schamroth on himself[4]) is a popular test for clubbing. When the distal phalanges (bones nearest the fingertips) of corresponding fingers of opposite hands are directly apposed (placed against each other back to back), a small diamond-shaped "window" is normally apparent between the nailbeds. If this window is obliterated, the test is positive and clubbing is present.

When clubbing is encountered in patients, doctors will seek to identify its cause. They usually accomplish this by obtaining a medical history— particular attention is paid to lung, heart, and gastrointestinal conditions —and conducting a clinical examination, which may disclose associated features relevant to a diagnosis. Additional studies such as a chest x-ray may also be performed.

  • Clubbing of the fingernail. The red line shows the outline of a clubbed nail.

    Clubbing of the fingernail. The red line shows the outline of a clubbed nail.

Physical Examination

Extremities

Clubbing[5]


Disease associations

Although many diseases are associated with clubbing (particularly lung diseases), the reports are fairly anecdotal. Prospective studies of patients presenting with clubbing have not yet been performed, and hence there is no conclusive evidence of these associations.

Isolated clubbing

Clubbing is associated with:

  • Others:
    • Hyperthyroidism (thyroid acropachy)[9]
    • Familial and racial clubbing and "pseudoclubbing" (people of African descent often have what appears to be clubbing)
    • Vascular anomalies of the affected arm such as an axillary artery aneurysm (in unilateral clubbing)

Clubbing associated with other symptoms

HPOA

Main article: Periosteal reaction
Bone scan of a patient with Marie-Bamberger syndrome

A special form of clubbing is hypertrophic pulmonary osteo-arthropathy, known in continental Europe as Pierre Marie-Bamberger syndrome. (In dogs the condition is known as hypertrophic osteopathy.) This is the combination of clubbing and thickening of periosteum (connective tissue lining of the bones) and synovium (lining of joints), and is often initially diagnosed as arthritis. It is commonly associated with lung cancer.

Primary HOA

Primary hypertrophic osteo-arthropathy is HPOA without signs of pulmonary disease. This form has a hereditary component, although subtle cardiac abnormalties can occasionally be found. It is known in continental Europe as the Touraine-Solente-Golé syndrome. This condition has been linked to mutations in the gene on the fourth chromosome (4q33-q34)coding for the enzyme 15-hydroxyprostaglandin dehydrogenase (HPGD); this leads to decreased breakdown of prostaglandin E2 and elevated levels of this substance.[10]

Secondary HOA

It is usually associated with lung cancer, pulmonary infections, cystic fibrosis, right-to-left cardiac shunts, and less often in Hodgkin lymphoma and cirrhosis. Among patients with lung cancer, HOA is most frequently associated with adenocarcinoma and least frequently with small cell carcinoma [11] Rarely, arterial vascular prosthesis infections may be associated with HOA[12]. Clinical features suggestive of vascular infection-related HOA include clubbing or periosteal new bone formation in a single limb.


See also


Complete Differential Diagnosis of the Causes of Clubbing

(In alphabetical order)


Complete Differential Diagnosis of the Causes of Clubbing

(By organ system)

Cardiovascular Cyanotic congenital heart disease, right-to-left shunting, [[bacterial endocarditis, Tetralogy of Fallot, Total anomalous venous return, Transposition of the great vessels, Tricuspid atresia, Truncus arteriosus, arteriovenous malformations , arterial vascular prosthesis infections, Atrial myxoma
Chemical / poisoning Cannabis
Dermatologic No underlying causes
Drug Side Effect Cannabis
Ear Nose Throat No underlying causes
Endocrine No underlying causes
Environmental No underlying causes
Gastroenterologic ulcerative colitis, Crohn disease, primary biliary cirrhosis, cirrhosis of the liver, leiomyoma of the esophagus, achalasia, and peptic ulcer of the esophagus, Celiac Sprue
Genetic No underlying causes
Hematologic No underlying causes
Iatrogenic Cannabis
Infectious Disease No underlying causes
Musculoskeletal / Ortho No underlying causes
Neurologic No underlying causes
Nutritional / Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic Thyroid cancer, thymus cancer, Hodgkin's disease, POEMS, metastatic melanoma
Opthalmologic No underlying causes
Overdose / Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary lung cancer, cystic fibrosis, interstitial lung disease, idiopathic pulmonary fibrosis, sarcoidosis,lipoid pneumonia, empyema, pleural mesothelioma, pulmonary artery sarcoma, cryptogenic fibrosing alveolitis, pulmonary metastases, Bronchiectasis
Renal / Electrolyte No underlying causes
Rheum / Immune / Allergy No underlying causes
Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Miscellaneous No underlying causes


References

  1. ↑ Vandemergel X, Renneboog B (2008). "Prevalence, aetiologies and significance of clubbing in a department of general internal medicine". Eur. J. Intern. Med. 19 (5): 325–9. doi:10.1016/j.ejim.2007.05.015. PMID 18549933. Unknown parameter |month= ignored (help)
  2. ↑ Uppal S, Diggle CP, Carr IM, et al (June 2008). "Mutations in 15-hydroxyprostaglandin dehydrogenase cause primary hypertrophic osteoarthropathy". Nat. Genet. 40 (6): 789–93. doi:10.1038/ng.153. PMID 18500342
  3. ↑ Myers KA, Farquhar DR (2001). "The rational clinical examination: does this patient have clubbing?". JAMA. 286: 341–7. doi:10.1001/jama.286.3.341. PMID 11466101.
  4. ↑ Schamroth L (1976). "Personal experience". S. Afr. Med. J. 50 (9): 297–300. PMID 1265563. Unknown parameter |month= ignored (help)
  5. ↑ http://picasaweb.google.com/mcmumbi/USMLEIIImages
  6. ↑ Sridhar KS, Lobo CF, Altman RD. Digital clubbing and lung cancer. Chest 1998;114:1535-37. PMID 9872183
  7. ↑ Epstein O, Dick R, Sherlock S (1981). "Prospective study of periostitis and finger clubbing in primary biliary cirrhosis and other forms of chronic liver disease". Gut. 22 (3): 203–6. PMID 7227854.
  8. ↑ Naeije R. Hepatopulmonary syndrome and portopulmonary hypertension. Swiss Med Wkly. 2003;133:163-9. PMID 12715285.
  9. ↑ Template:GPnotebook
  10. ↑ Uppal S, Diggle CP, Carr IM; et al. (2008). "Mutations in 15-hydroxyprostaglandin dehydrogenase cause primary hypertrophic osteoarthropathy". Nat. Genet. 40 (6): 789–93. doi:10.1038/ng.153. PMID 18500342. Unknown parameter |month= ignored (help)
  11. ↑ Sridhar KS, Lobo CF, Altman RD (1998). "Digital clubbing and lung cancer". Chest. 114 (6): 1535–7. PMID 9872183. Unknown parameter |month= ignored (help)
  12. ↑ Alonso-Bartolomé P, Martínez-Taboada VM, Pina T, Blanco R, Rodriguez-Valverde V (2006). "Hypertrophic osteoarthropathy secondary to vascular prosthesis infection: report of 3 cases and review of the literature". Medicine (Baltimore). 85 (3): 183–91. doi:10.1097/01.md.0000224714.27508.8b. PMID 16721260. Unknown parameter |month= ignored (help)
  13. ↑ Schuller A, Cottin V, Hot A, Cordier JF (2008). "Finger clubbing and altered carbon monoxide transfer capacity in cannabis smokers". Eur. Respir. J. 31 (2): 473–4. doi:10.1183/09031936.00150907. PMID 18238953. Unknown parameter |month= ignored (help)
  14. ↑ Pineda CJ, Guerra J, Weisman MH, Resnick D, Martinez-Lavin M (1985). "The skeletal manifestations of clubbing: a study in patients with cyanotic congenital heart disease and hypertrophic osteoarthropathy". Semin. Arthritis Rheum. 14 (4): 263–73. PMID 3909407. Unknown parameter |month= ignored (help)
  15. ↑ Mullins GM, Lenhard RE (1971). "Digital clubbing in Hodgkin's disease". Johns Hopkins Med J. 128 (3): 153–7. PMID 5553121. Unknown parameter |month= ignored (help)
  16. ↑ Thompson MA, Warner NB, Hwu WJ (2005). "Hypertrophic osteoarthropathy associated with metastatic melanoma". Melanoma Res. 15 (6): 559–61. PMID 16314744. Unknown parameter |month= ignored (help)
  17. ↑ Loredo JS, Fedullo PF, Piovella F, Moser KM (1996). "Digital clubbing associated with pulmonary artery sarcoma". Chest. 109 (6): 1651–3. PMID 8769527. Unknown parameter |month= ignored (help)
  18. ↑ West SG, Gilbreath RE, Lawless OJ (1981). "Painful clubbing and sarcoidosis". JAMA. 246 (12): 1338–9. Unknown parameter |month= ignored (help)

Template:Skin and subcutaneous tissue symptoms and signs Template:Nervous and musculoskeletal system symptoms and signs Template:Urinary system symptoms and signs Template:Cognition, perception, emotional state and behaviour symptoms and signs Template:Speech and voice symptoms and signs Template:General symptoms and signs

Template:SIB

de:Trommelschlägelfinger it:Dita_ippocratiche no:Trommestikkfingre


Template:WikiDoc Sources

Retrieved from "https://www.wikidoc.org/index.php?title=Clubbing&oldid=546043"