Clubbing

Synonyms

Digital clubbing; Hippocratic fingers; Drumstick fingers; Hypertrophic osteoarthropathy; HOA; Pierre Marie-Bamberger syndrome; Acropachy; Pachydermoperiostosis

Definition and Characteristics

Clubbing, the most ancient clinical sign of medicine (Hippocrates, fifth century BC), is characterized by thickening and widening of the tips of the fingers and/or toes due to excessive lay down of collagen and interstitial edema. The nails become convexes (“watch-crystal nail”). Although most often symmetrical, clubbing can be unilateral or even unidigital. Clubbing can occur in isolation or associated with HOA that represents the fully developed expression of the disorder. HOA is defined by the presence of digital clubbing (DC) and periosteal proliferation (periostosis) of the distal end of the tubular bones [1].

DC is usually painless. If associated with HOA, burning of the fingertips or deep-seated pain may occur. Particularly in association with malignancies, painful arthropathy may...