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FAQ: How do you check for finger clubbing?

Common symptoms of clubbing:

  1. The nail beds soften. The nails may seem to “float” instead of being firmly attached.
  2. The nails form a sharper angle with the cuticle.
  3. The last part of the finger may appear large or bulging.
  4. The nail curves downward so it looks like the round part of an upside-down spoon.

Where can I check clubbing?


  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.

How is clubbing measured?

The ratio of the anteroposterior diameter of the finger at the nail bed (a–b) to that at the distal interphalangeal joint (c–d) is a simple measurement of finger clubbing. It can be obtained readily and reproducibly with calipers. If the ratio is > 1, clubbing is present.

How do you assess for digital clubbing?

Digital clubbing can be detected through various tests. Of these tests, Myers et al1 recommend assessment of profile angle and phalangeal depth ratio (Figure 1). A profile angle that approaches a straight line (180°) or phalangeal depth ratio that exceeds 1.0 is rare in people with no disease.

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What are the stages of clubbing?


  • No visible clubbing – Fluctuation (increased ballotability) and softening of the nail bed only.
  • Mild clubbing – Loss of the normal <165° angle (Lovibond angle) between the nailbed and the fold (cuticula).
  • Moderate clubbing – Increased convexity of the nail fold.

How do you check club fluctuation?

To elicit ‘fluctuation’, the patient’s finger (index finger) is placed on the pulp of examiner’s two thumbs and held in this position by gentle pressure with the tips of examiner’s middle fingers applied on the patient’s proximal interphalangeal joint.

What does nail clubbing indicate?

Nail clubbing is sometimes the result of low oxygen in the blood and could be a sign of various types of lung disease. Nail clubbing is also associated with inflammatory bowel disease, cardiovascular disease, liver disease and AIDS.

How do you reverse clubbing fingers?

No specific treatment for clubbing is available. Treatment of the underlying pathological condition may decrease the clubbing or, potentially, reverse it if performed early enough. Once substantial chronic tissue changes, including increased collagen deposition, have occurred, reversal is unlikely.

Does asthma cause clubbing?

Clubbing is also seen infrequently in extrinsic allergic vasculitis, pulmonary arteriovenous malformations, bronchiolitis obliterans, sarcoidosis, and chronic asthma. Box 1.3 shows a list of nonpulmonary diseases associated with clubbing.

Is nail clubbing always bad?

It may be harmless. But it can block your blood flow. If a myxoma is the cause of your clubbing, you may also have: Trouble breathing.

Does empyema cause finger clubbing?

Since Hippocrates first described digital clubbing in patients with empyema, digital clubbing has been associated with various underlying pulmonary, cardiovascular, neoplastic, infectious, hepatobiliary, mediastinal, endocrine, and gastrointestinal diseases.

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Is clubbing seen in COPD?

Chronic obstructive pulmonary disease (COPD) per se does not cause clubbing, but if clubbing is present in COPD, underlying lung cancer and bronchiectasis must be ruled out.

Does TB cause finger clubbing?

Finger clubbing was observed in 21% of 70 adult Nigerian patients presenting with pulmonary tuberculosis. These patients had a significantly higher incidence of haemoptysis and they also showed a significantly lower body weight and serum albumin than those without clubbing.

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