Clubbing of the fingers is caused by dilation of arteries and capillaries in the fingers, leading to soft tissue swelling and hypertrophy. It is characterized by an increased Lovibond angle (>180 degrees), positive Schamroth sign, and a phalangeal depth ratio >1. Clubbing can be primary/idiopathic or secondary due to underlying conditions affecting the lungs, heart, liver, or endocrine system. It is classified as unilateral/bilateral, acute/chronic, and primary/secondary based on characteristics.

1. Akshai George Paul

3. NORMAL FINGERS CLUBBED FINGERS

5.  Because it was hippocrates who first
described this clinical feature

6.  Soft tissue swelling is due to interstitial
edema and dilation of arteries and capillaries

7. 1.Dilation of AV anastomosis
In clubbing av anastomosis increases the
fingers.this leads to the hypertrophy of
tissues in the nail bed.
2.Increased pressure gradient
It is between radial arteries and digital
arteries which causes edema
3.Cappillary stasis
4.Vitamin deficency and hormonal disorders

8. 1.Lovibond angle >180 degree
2.Schamroth sign positive
3.Phalangeal depth ratio>1

9. Angle between the nail bed and
nail.Normally it is an obtuse angle about
160 degrees.
In clubbing lovibond angle > 180 degrees.

11. When two fingers are held togetherwith
their nails facing each other,a space is
seen at the nail folds called shamroth
window.It is lost in clubbing

12. Grade I:
Softening of the nail beds and fluctuation
Grade II:
Drumstick type
Grade III:
Parrot beak
Grade IV:
Hypertropic osteoarthropathy

15. I.Bronchopulmonary diseases.
1.Bronchiectasis
2.Lung abscess
3.Bronchiogenic carcinoma
4.Emphysema
5.mesothelioma
II.Cardiac diseases
1.Congenital cyanotic heart disease
2.Subacute bacterial endocarditis
3.Fallot`s tetrology

16. III.GIT diseases
1.Ulcerative colitis
2.Cirrhosis of liver
IV.Endocrine disorders
1.Thyrotoxicosis
2.Acromegaly

17.  1.Unilateral or bilateral
 2.Acute or chronic
 3.Primary or secondry

18.  Acute clubbing develops within 2-3 weeks.
 Mostly seen in: Lung abscess
Bacterial endocarditis

19.  Chronic clubbing develops in about 6 months
as in cyanotic heart diseases such as
Tetralogy of Fallot.
 In bronchiectasis clubbing may take upto
1year to develop

20.  Seen a single limb

24.  Primary form of clubbing is generally
idiopathic or hereditary.
 Pachydermopriostosis contributes to about
85% of primary form of clubbing.

25.  Secondary form of clubbing is mostly
secondary to systemic illness affecting
mainly respiratory system, cardiovascular
system, hepatobiliary system and
gastrointestinal system, and hence is
bilateral in general.

26.  As the name suggests, it refers to
appearance of clubbing without actual
presence of it, seen in:
 Hyperparathyroidism: there is excessive
resorption of distal phalanges
 Hansen’s disease
 Leukemia: bone destruction due to secondary
deposits

27.  C-Congenital heart disease,cirrhosis
 LU-Lung abscess
 B-Bronchiectasis
 B-Bronchiogenic carcinoma
 IN-Infective endocarditis
 G-GIT disorders like ulcerative colitis