Nail Signs Clubbing 杵状指

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.



许多系统性疾病与杵状指相关:如: 先天性心脏病,肺动静脉畸形(常为遗传性出血性毛细血管扩张症),囊性纤维化,原发性肥厚性骨关节病,原发性或转移性癌症,胸膜肿瘤,肺部脓肿,结核,支气管扩张,肺纤维化,结节病,动脉瘤或透析瘘(单侧杵状指),充血性心力衰竭,细菌性心内膜炎,炎性肠病,阿米巴病,蛔虫病,慢性活动性肝炎,肝硬化,HIV感染,甲状腺功能亢进,继发性甲状旁腺功能亢进。


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