Finger clubbing

Finger clubbing, also called "drumstick fingers", is a common clinical sign in patients with heart or lung disease. The term is used to describe an enlargement of the distal phalanges of the fingers, giving them a drumstick or club-like appearance. 

Clinical Presentation

Finger clubbing presents in a number of typical stages:

1. increased fluctuation of the nail bed
2. loss of the normal Lovibond angle at the base of the nail (Schamroth's window is lost)
3. increased convexity of the nail
4. widening or 'drumsticking' of the fingertip

Pathology

The underlying pathogenesis of finger clubbing is unknown.

Associations

Finger clubbing is associated with a long list of chronic cardiopulmonary and GI diseases including ¹:

• pulmonary disease
  • lung cancer
    • usually non-small cell carcinoma
  • mesothelioma
  • idiopathic pulmonary fibrosis
  • chronic suppurative pulmonary diseases
    • bronchiectasis
    • empyema
    • lung abscess
    • cystic fibrosis
• cardiac disease
  • long-standing cyanotic congenital heart disease
  • atrial myxoma
  • infective endocarditis
• GI disease
  • inflammatory bowel disease, especially Crohn disease
  • cirrhosis
  • gastrointestinal lymphoma
  • celiac disease
• others
  • thyrotoxicosis (i.e. thyroid acropachy)
  • familial - generally prepubescent