Clubbing of Fingers

A 55-year-old man claims that the clubbed appearance of his fingers had been present “as long as I can remember.” This patient has hereditary clubbing of the distal phalanges of all fingers; his toes are similarly affected.

The patient had no history of pulmonary, cardiac, or gastrointestinal disease. He reports that most members of his family have clubbing of all fingers and toes.

Clubbing is a bullous enlargement of the distal ends of the fingers and toes that represents an increase in connective tissue, especially on the dorsal surfaces of the digits. Clubbing can be hereditary, idiopathic, or acquired and is associated with many lung diseases, including primary and metastatic cancer, abscess, bronchiectasis, and mesothelioma. Persons with cyanotic congenital heart disease; infective endocarditis; and gastrointestinal conditions, such as regional enteritis, chronic ulcerative colitis, and herpetic cirrhosis, also exhibit clubbing.

Clubbing is a major characteristic of hypertrophic osteoarthropathy, particularly in the disease's early stage. Pain and symmetric arthritis-like changes in the shoulders, knees, ankles, wrists, and elbows also affect patients with hypertrophic osteoarthropathy.