The terminal portion of fingers and toes are usually of the same size and gently taper at the tip. In certain conditions the soft tissues proliferate in the terminal portion of fingers and toes and give them an appearance of club. When this occurs, patient is said to have clubbing.

Method of Exam

  1. View the fingers from a dorsal and lateral view. Note the width of terminal portion and compare with the proximal part.
  2. Look at the angle between the nail and skin.
  3. Inspect the periungual skin.
  4. Elicit fluctuation of the nail bed.
  5. Attempt to feel the posterior edge of nail.




Clubbing has been observed with:

  1. Intrathoracic malignancy : Primary or secondary ( lung, pleural, mediastinal).
  2. Suppurative lung disease : (lung abscess, bronchiectasis, empyema).
  3. Diffuse interstitial fibrosis : Alveolar capillary block syndrome.
  4. In association with other system disorders.


Patient had clubbing of fingers and toes. That helps a great deal in suspecting the etiology of his pleural effusion. Empyema and malignancy are known to be associated with clubbing.