Introduction
What is digital/nail clubbing?
Digital/nail clubbing is a condition whereby the nails appear wider, sponge-like or swollen, like a spoon that is facing upside-down. Clubbed fingers are often a sign of an underlying medical condition that requires attention, such as cancer of the lung. When the condition responsible for clubbing is treated, the clubbed nails may return to their normal shapes.
Digital clubbing, or finger clubbing, is characterized by the enlargement of the fingertips and a change in the angle of the nail.
When this occurs, it is usually painless and harmless. It is a sign of an underlying health condition such as cancer. It may also occur in isolation, for example familial clubbing as an autosomal dominant trait.
Acronym
Nail clubbing is a sign of any of the following conditions as underlying diseases;
CLUBBING:
- C- Cyanotic heart disease
- C- Cystic fibrosis
- L- Lung cancer
- L- Lung abscess
- U- Ulcerative colitis
- B- Bronchiectasis
- B- Benign mesothelioma
- I- Infective endocarditis
- I- Idiopathic pulmonary disease
- N- Neurogenic tumors
- G- Gastro-intestinal disease
Key Facts & Statistics
What are the key facts and statistics about digital clubbing?
Clubbing is associated with various diseases:
- Lung and heart diseases; 80-90%
- Gastro-intestinal diseases; 5%
- Thyroid disorders; 1%
- Palmoplantar keratoderma
Risk Factors
What are the risk factors associated with digital clubbing?
1.Chronic Lung Diseases
- Cystic Fibrosis
- Bronchiectasis
- Interstitial Lung Disease
- Lung Cancer
2. Cardiovascular Conditions
- Congenital Heart Diseases
- Endocarditis
3. Gastrointestinal Disorders
- Inflammatory Bowel Disease (IBD)
- Cirrhosis of the Liver
4. Infections
5. Genetic Factors
- Hereditary Conditions (e.g., primary hypertrophic osteoarthropathy)
6. Other Conditions
- Hyperthyroidism
- Certain Cancers (e.g., malignancies associated with paraneoplastic syndromes)
7. Environmental Factors
- Exposure to certain toxins (e.g., asbestos)
8. Smoking
Causes
What are the causes of nail clubbing?
- Digestive disorders such as celiac and crohn’s diseases.
- Liver cirrhosis.
- Cancers such as lung cancer and hodgkin lymphoma
- Thyroid disorders such as Grave’s disease and Hyperthyroidism among other disorders.
- Bronchiectasis (including cystic fibrosis)
- Fibrosing alveolitis.
Signs & Symptoms
What are the signs and symptoms of digital/nail clubbing?
- Nail curves downward(upside-down spoon).
- Softened nail bed.
- Nails form a sharper angle from the cuticle.
- The last part/region of the finger bulges and appears warm and reddish in color.
Diagnosis
- Family and medical history.
- Physical examination of the fingers, nails, chest and lungs.
- Tests include:
- Blood gas analysis
- Chest CT scan
- Chest X-ray
- ECHO(echocardiogram)
- Pulmonary function tests
- Electrocardiogram
Treatment & Management
How is digital clubbing treated?
Being a sign of an underlying health condition, it requires practitioners to correctly identify the condition and treat it appropriately. For example:
- Chemotherapeutic and radiotherapeutic agents for lung cancer
- Surgery for heart disease
- Medications for hyperthyroidism
Prevention
How do we prevent nail clubbing?
Currently, there is no known methods to prevent nail clubbing.
Preventing conditions that are responsible for nail clubbing can help prevent it.
Some of the practices that can be embraced are:
- Regular heath check-ups for physical examinations.
- Avoid smoking. Smoking is an unhealthy practice that is a cause of lung cancer and heart disease.
- Avoid drinking excessive amounts of alcohol as this can cause cirrhosis of the liver.