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
- View the fingers from a dorsal and lateral view. Note the width of terminal
portion and compare with the proximal part.
- Look at the angle between the nail and skin.
- Inspect the periungual skin.
- Elicit fluctuation of the nail bed.
- Attempt to feel the posterior edge of nail.
- The terminal portion is of the same size as the proximal portion.
- The angle between the nail and skin is less than 180o.
- The periungual skin is normal.
- There is no fluctuation of nail bed.
- You cannot feel the posterior edge of nail.
- In clubbing, there is widening of the AP and lateral diameter of terminal portion
of fingers and toes giving the appearance of clubbing.
- The angle between the nail and skin is greater
- The periungual skin is stretched and shiny.
- There is fluctuation of the nail bed.
- One can feel the posterior edge of the nail.
Clubbing has been observed with:
- Intrathoracic malignancy : Primary or secondary ( lung, pleural, mediastinal).
- Suppurative lung disease : (lung abscess, bronchiectasis, empyema).
- Diffuse interstitial fibrosis : Alveolar capillary block syndrome.
- 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