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Clubbing of the fingers or toes

Definition

Clubbing is changes in the areas under and around the toenails and fingernails that occur with some disorders. The nails may also show changes.

Alternative Names

Clubbing

Considerations

Common symptoms of clubbing:

  • The nail beds soften. The nails may seem to "float" instead of being firmly attached.
  • The nails form a sharper angle with the cuticle.
  • The last part of the finger may appear large or bulging. It may also be warm and red.
  • The nail curves downward so it looks like the round part of an upside-down spoon.

Clubbing can develop quickly, often within weeks. It also can go away quickly when its cause is treated.

Causes

Lung cancer is the most common cause of clubbing. Clubbing often occurs in heart and lung diseases that reduce the amount of oxygen in the blood. These may include:

Other causes of clubbing:

When to Contact a Medical Professional

If you notice clubbing, contact your health care provider.

What to Expect at Your Office Visit

A person with clubbing often has symptoms of another condition. Diagnosing that condition is based on:

  • Family history
  • Medical history
  • Physical exam that looks at the lungs and chest

The provider may ask questions such as:

  • Do you have any trouble breathing?
  • Do you have clubbing of the fingers, toes, or both?
  • When did you first notice this? Do you think it is getting worse?
  • Does the skin ever have a blue color?
  • What other symptoms do you have?

The following tests may be done:

There is no treatment for the clubbing itself. The cause of clubbing can be treated, however.

Gallery

Clubbing
Clubbing may result from chronic low blood-oxygen levels. This can be seen with cystic fibrosis, congenital cyanotic heart disease, and several other diseases. The tips of the fingers enlarge and the nails become extremely curved from front to back.
Clubbing
Clubbing may result from chronic low blood-oxygen levels. This can be seen with cystic fibrosis, congenital cyanotic heart disease, and several other diseases. The tips of the fingers enlarge and the nails become extremely curved from front to back.

References

Drake WM, Chowdhury TA. General patient examination and differential diagnosis. In: Glynn M, Drake WM, eds. Hutchison's Clinical Methods. 25th ed. Philadelphia, PA: Elsevier; 2023:chap 2.

Fajardo E, Davis JL. History and physical examination. In: Broaddus VC, Ernst JD, King TE, Lazarus SC, Sarmiento KF, Schnapp LM, Stapleton RD, eds. Murray and Nadel's Textbook of Respiratory Medicine. 7th ed. Philadelphia, PA: Elsevier; 2022:chap 18.

Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM. Cyanotic congenital heart lesions: lesions associated with decreased pulmonary blood flow. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 457.

Last reviewed April 25, 2023 by Charles I. Schwartz, MD, FAAP, Clinical Assistant Professor of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, General Pediatrician at PennCare for Kids, Phoenixville, PA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team..

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