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Clubbed Fingers

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What is Clubbing ?

Clubbed Fingers, also known as Digital Clubbing, is the presence of a characteristically "drumstick" or "light bulb" shape to one or more of the finger tips.

* Clubbing can also occur in the toes but is usually easier to see "clubbing" of the fingers.

What Causes Clubbed Fingers ?

There are multiple causes of club-shaped fingers. Onset of clubbing is usually slow (over a period of months or years) but can be rapidly occuring as well. Clubbed fingers should always be evaluated by a physician, especially if the clubbing occurs quickly.
Causes of Finger Clubbing
Causes Include (but are not limited to):
- Genetics
-- Hypertrophic Osteoarthropathy (HOA)

- Lung Diseases
-- Asbestosis or Mesothelioma (due to Asbestos exposure)
-- Cancer
-- Coal Mine Dust Exposure
-- Chronic Lung Inflammation
-- Cystic Fibrosis
-- Hypersensitivity pneumonitis
-- Pigeon Exposure (i.e. Pigeon Breeders)
-- Scarring / Fibrosis of the Lung
-- Tuberculosis

- Cardiovascular or Heart Disease
-- Aneurysm

- Infection

- Nerve Injury

- Liver Disease

- Lupus erythematosus

- Paralysis or Weakness of Affected Fingers

- Parasite Infection (i.e. Whipworm)

- Sarcoidosis

- Thyroid Disease

- Blood or Blood Vessel Abnormalities
-- Thrombocythemia (Platelet count too high, Over 450,000 per microliter)

- Gastrointestinal Disease (Including IBD)
Gastrointestinal Diseases Associated with Clubbing
Although Clubbing can have multiple different underlying causes, there is a distinct correlation between patients with Clubbing of the Digits and Inflammatory Bowel Disease. The severity of clubbing is also correlated to IBD activity.
Finger Clubbing and Crohn's Disease
Finger Clubbing is found in 58% of patients with Crohn's Disease and only in about 5% of patients with Ulcerative Colitis.

62% of Crohn's patients with involvement of the Large Intestine exhibited Finger Clubbing in contrast to 54% of patients who had their Crohn's restricted to the Small Intestine.

69% of Patients who had Crohn's Symptoms in both the Small and Large Intestine also had Finger Clubbing.

Crohn's patients who were symptom-free either by Intestinal Resection or treatment with Medication also had a dramatic decrease in "Clubbing Grade" and/or complete resolution of Clubbing entirely. [3]

Celiac Disease

Grades of Digital Clubbing

Grade I: Slight [3][4][7]
Increased fluid buildup of the skin at the base of the nail.

Grade II: Moderate[3][4][7]
"Parrot Beak" Loss Angle between Nail and Nail Bed. Curved Fingernail

Grade III: Severe[3][4][7]
"Drum Stick" Appearance. Exaggerated Curve of the Fingernail

Grade IV: Severe[4][7]
Bone Changes in Wrists, Ankles, Elbows or Knees.

Treatment for Digital Clubbing

Generally, your physician will run multiple tests to determine the underlying cause of your finger (or toe) clubbing.

With successful treatment of the underlying condition, clubbing can go away very quickly (within weeks).

References

1. Bigler FC. The morphology of clubbing. Am J. Pathol. 1958; 34(2):237-261. http://www.ncbi.nlm.nih.gov/pmc/arti...00580-0035.pdf

2. Spicknall KE, Zirwas MJ, English III JC. Clubbing: An update on diagnosis, differential diagnosis, pathophysiology, and clinical relevance. J Am Acad Dermatol. 2005; 52: 1020-1028. http://www.hakeem-sy.com/main/files/51.pdf

3. Fielding JF and Cooke WT. Finger Clubbing and regional enteritis. Gut. 1971; 12: 442-444. http://www.ncbi.nlm.nih.gov/pmc/arti...00655-0036.pdf

4. http://www.scribd.com/doc/55943628/I...k-Color-Typing

5. Myers K, Farquhar DRE. Does this patient have clubbing. JAMA 2001; 286(3): 341-347. http://jama.jamanetwork.com/data/Jou...7/JRC00000.pdf

6. Schwartz RA. Clubbing of the Nails Clinical Presentation. Medscape Reference. Drugs, Diseases & Procedures. Elston DM Editor. Updated Feb 2012. Accessed July 2012. http://emedicine.medscape.com/articl...clinical#a0217

7. Finger / Digital Clubbing http://www.surgicalnotes.co.uk/conte...gital-clubbing

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