1. CLUBBING
First described by Hippocrates about
2500yrs ago, hence also called as
Hippocratic finger
ABHIJIT SAMAL
080201386

2. DEFINITION
• Thickening of the tissues at the base of the
finger and toe nails such that the normal angle
between the nail & the digit is filled in.

3. Pathophysiology
• VEGF is the key entity, platelet derived growth
factor stimulated by hypoxia and produced in
diverse malignancies.
• VEGF induces vascular hyperplasia, edema,
and fibroblast or osteoblast proliferation at
peripheral levels in nails

4. CAUSES
• thoracic & non-thoracic
• THORACIC causes: bronchitis, empyema, lung abscess, cystic
fibrosis, Lung Ca, Esophageal Ca,
mesothelioma, Bac. Endocarditis.
» Interstitial lung disease: asbestosis, fibrosing
alveolitis.
» Vascular causes: AV malformations, Cyanotic
heart disease.
• Non-thoracic causes: Hepatic cirrhosis, Ulcerative colitis,
Crohn’s disease.

5. Criteria
• Loss of normal angle between nail and nail
bed.
• Inc. Nail bed fluctuation
• Inc. nail bed curvature in the later stages
• Inc. bulk of soft tissue over the terminal
phalanges

7. Grades of clubbing
• Grade 1: Nail bed fluctuation
• Grade 2: Obliteration of Lovibond angle
• Grade 3: Parrot beaking
• Grade 4: Hypertrophic osteo-
arthropathy(HOA)

8. Parrot beak app.
Drumstick appearance

9. Hypertrophic Osteo-arthropathy
• Earlier known as hypertrophic pulmonary
osteo-arthropathy(HPOA)
• Syndrome of clubbing of the digits, periostitis
of the long bones and arthritis.
• Primary: occurs w/o any underlying cause and
is familial
• Secondary: pulmonary, cardiac, hepatic,
intestinal disease.

10. Hypertrophic Osteo-arthropathy
• Earlier known as hypertrophic pulmonary
osteo-arthropathy(HPOA)
• Syndrome of clubbing of the digits, periostitis
of the long bones and arthritis.
• Primary: occurs w/o any underlying cause and
is familial
• Secondary: pulmonary, cardiac, hepatic,
intestinal disease.