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clubbing

clubbing

introduction

  • clubbing of the nails in association with lung infection was 1st described by Hippocrates
  • mechanism is unclear

4 phases of clubbing

  1. nail bed fluctuation
  2. loss of the normal nail-cuticle angle (Lovibond angle which is normally 15deg)
  3. clubbed fingertip appearance with increased convexity of nail
  4. loss of normal skin creases, shiny change to nail and longitudinal striation of nail

hypertrophic osteoarthropathy (HOA)

  • formerly known as hypertrophic pulmonary osteoarthropathy (HPOA)
  • syndrome of clubbing, periostitis of the long bones, and arthritis
  • primary form is usually familial and affects infants and adolescents primarily, with male:female ratio of 9:1
  • secondary form mainly affects the elderly and is associated with an underlying pulmonary, cardiac, hepatic, or intestinal disease

DDx of clubbing

primary clubbing (rare)

  • idiopathic hereditary clubbing
    • genetic dominant trait
  • pachydermoperiostosis
    • rare genetic disorder with pachydermia, digital clubbing, periostosis, mainly affecting young males
  • primary hypertrophic osteoarthropathy (PHO)
    • rare genetic disorder with digital clubbing, subperiosteal new bone formation, and arthropathy
    • linked to mutations in the 15-hydroxy-prostaglandin dehydrogenase (15-PGDH) encoding gene HPGD

secondary clubbing

clubbing.txt · Last modified: 2012/10/02 08:32 by gary1