Why does clubbing occur

Lung India. Burcovschii S, Aboeed A. Nail Clubbing. StatPearls Publishing. Updated April 2, Jamieson A. The causes of finger clubbing: a list worth learning. Am J Med. Nail changes in patients with liver disease. J Eur Acad Dermatol Venereol. Clubbing of fingers and ROS. Published April 1, Bozzao, F. Hypertrophic osteoarthropathy mimicking a reactive arthritis: a case report and review of the literature. BMC Musculoskelet Disord. The microanatomic basis of finger clubbing - a high-resolution magnetic resonance imaging study.

J Rheumatol. Tully A, Trayes K. Evalution of nail abnormalities. American Family Physician. Your Privacy Rights. To change or withdraw your consent choices for VerywellHealth. At any time, you can update your settings through the "EU Privacy" link at the bottom of any page. Damage to blood vessels, or injuries or deformities that block them, can reduce circulating oxygen levels and trigger clubbing.

To diagnose clubbing, a doctor will perform a physical examination of the impacted fingers and take a complete patient history, asking questions about the presence or absence of symptoms of conditions associated with clubbing. If clubbing is present, a doctor will normally order imaging tests to evaluate the lungs and heart, such as a chest X-ray. If these images are clear or inconclusive, a doctor may order a CT scan to look for abnormal growths.

Dozens of other tests can help determine the underlying condition and its severity, including blood tests, blood gas tests, and tests that assess lung function. A doctor may also require biopsies and exploratory surgeries to diagnose or rule out the presence of certain GI conditions, cancer, autoimmune disorders, and blood vessel conditions.

How likely someone is to fully recover from clubbing depends almost entirely on how severe or progressed the condition is, and how early a person seeks help from a doctor to diagnose and treat it. A person may also want to maintain their overall health by eating a healthful diet. This may help lower the risk of many of the health conditions that can cause clubbed fingers. Treating the underlying cause of clubbing can reverse this condition if the underlying condition also improves.

However, when chronic, malignant, or persistent conditions cause clubbing, the condition is often long-term. Anyone who thinks they may be experiencing clubbing should contact a medical professional as soon as possible. Getting proper treatment for the underlying cause of clubbing is usually crucial to a good outcome and reducing the risk of more serious, permanent complications.

Left untreated, several common conditions associated with clubbing can cause organ damage, disability, coma, and death. Clubbed fingers occur when the soft tissues of the fingers swell, become spongy, and slowly straighten the curvature of the nail bed.

Clubbing typically occurs as the result of chronic gastrointestinal conditions or conditions that interfere with circulating oxygen levels.

Some genetic conditions can also cause clubbing. Cases of clubbing can resolve if treatment addresses the underlying cause. Talk to a doctor as soon as possible about potential clubbing to reduce the risk of serious, permanent complications. Cardiovascular disease affects the heart and blood vessels. These may include:. A person with clubbing often has symptoms of another condition.

Diagnosing that condition is based on:. General patient examination and differential diagnosis. Hutchison's Clinical Methods. Philadelphia, PA: Elsevier; chap 2. Fajardo E, Davis JL. History and physical examination. Murray and Nadel's Textbook of Respiratory Medicine. Philadelphia, PA: Elsevier; chap Kliegman RM, St. If 2 opposing fingers are held back to back against each other, a diamond-shaped space should normally appear between the nail beds and the nails of the 2 fingers.

In clubbing, this space or window is missing. Clubbing is usually bilateral, although unilateral clubbing does exist e. It is painless unless associated with underlying conditions such as pulmonary hypertrophic osteoarthropathy. The vast majority of patients are unaware of its presence. However, an understanding of the causation and diseases associated with clubbing alerts the physician to the seriousness of this sign and the need to investigate the patient appropriately.

Vascular endothelial growth factor VEGF is key. This platelet-derived factor is stimulated by hypoxia and produced in diverse malignancies and conditions that affect circulation. VEGF induces vascular hyperplasia, edema, and fibroblast or osteoblast proliferation at a peripheral level in the nails.

In primary pulmonary conditions such as lung cancer, this is the operative mechanism. When there is extrapulmonary shunting of blood - for example, in cyanotic heart disease - large megakaryocytic fragments gain access to the systemic circulation and affect distal sites such as the nails.