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.

clubbing

杵状指是希波克拉底在公元前一世纪首次描述，杵状指可能是先天性的或后天性的。后天性的杵状指并不常见，80％的患者与肺部疾病有关。杵状指是由远端手指的软组织增大引起的，导致球根状外观。指甲板扩大并过度弯曲，近端指甲褶皱与指甲板之间的角度加宽至大于180°。在肥厚性骨关节病中，杵状指与四肢肥大和疼痛性假性炎症性关节病有关。

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。

Reference:

  1. Antonella Tosti, Bianca Maria Piraccini. In: Jean Bolognia Julie Schaffer Lorenzo Cerroni, editors. Dermatology: 2-Volume Set 4th Edition. Elsevier; 2017. p1212
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  3. Myers KA, Farquhar DR. The rational clinical examination. Does this patient have clubbing? JAMA 2001;286:341–7
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  5. Roy HS, Wang Z, Ran H, Song W, Zheng Y. Diagnosis of digital clubbing by high‐frequency ultrasound imaging. Int J Dermatol 2013;52:1–5
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  7. Silveri F, Carlino G, Cervini C. The endothelium/platelet unit in hypertrophic osteoarthropathy. Clin Exp Rheumatol 1992;10(Suppl. 7):61–6.