Clubbing (Hippocratic Fingers) was described by Hippocrates in the first century BC, clubbing may be congenital or acquired. Acquired clubbing is uncommon and in 80% of patients is associated with pulmonary diseases.
Clubbing is caused by enlargement of the soft tissue of the distal digit, leading to a bulbous appearance. The nail plate is enlarged and excessively curved, with widening of the angle between the proximal nail fold and the nail plate to greater than 180°. In hypertrophic osteoarthropathy, clubbing is associated with hypertrophy of the extremities and painful pseudoinflammatory joint disease.
Systemic conditions associated with clubbing are: Congenital heart disease (usually cyanotic), Pulmonary arteriovenous malformations (often in the setting of hereditary hemorrhagic telangiectasia), Cystic fibrosis, Pachydermoperiostosis (primary hypertrophic osteoarthropathy, Neoplasms (primary or metastatic cancers, pleural tumors), Chronic infections (abscesses of the lungs, tuberculosis) Bronchiectasis, Pulmonary fibrosis, Sarcoidosis, Aneurysm or dialysis fistula (unilateral clubbing), Congestive heart failure, Bacterial endocarditis, Inflammatory bowel disease, Carcinomas, Infestations, e.g. amebiasis, ascariasis, Liver disorders, e.g. chronic active hepatitis, cirrhosis, HIV infection, Arterial graft sepsis (clubbing limited to perfused extremities), Thyroid disease (primarily hyperthyroidism), Secondary hyperparathyroidism.
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