What is Nail Clubbing?
Clubbing of the nails is a condition where the skin at the tip of your finger or toe swells, causing the nail to become straighter rather than curved. This phenomenon has been linked to other diseases way back since the time of Hippocrates, an ancient Greek physician. While clubbing can be seen alongside changes in the skin and bone structure, it can also occur on its own in rare instances.
Clubbing can appear due to a range of varied conditions, but sometimes it can happen without any obvious reason or it can run in families. In these cases, it’s known as idiopathic or familial clubbing, and in families, it often passes down as a dominant trait. This means that if one parent has it, there’s a good chance their children might have it too.
What Causes Nail Clubbing?
Nail clubbing, which is a change in the shape of your fingernails or toenails, can happen for a few reasons. These can include infections, cancer, inflammation, and problems with your blood vessels. There are many conditions that may cause nail clubbing, so if your nails start to change, it’s a good idea to check for underlying health issues.
However, isolated nail clubbing (where only one nail is clubbed) can sometimes be nothing to worry about and be simply due to your genetics. But because there are so many health conditions related to nail clubbing, it’s still important to rule out any potential health issues if this change occurs.
Risk Factors and Frequency for Nail Clubbing
Nail clubbing is a condition that affects only a small number of people – about 1% of all internal medicine hospital admissions – and is associated with a serious underlying disease in 40% of these cases. However, not everyone with an underlying disease will show signs of nail clubbing, making it difficult to estimate how often this condition truly occurs.
Among adults, the most common cause of nail clubbing is lung disease, specifically lung cancer, which accounts for 80% of cases. Other lung conditions, such as pleural tumors, and intrathoracic and mediastinal growth, are responsible for an additional 15% of clubbing cases. Despite being a major cause, clubbing only affects 5% to 15% of lung cancer patients. The occurrence of clubbing in association with other diseases, like interstitial lung disease, heart disease, gastrointestinal disease, infectious disease, and other types of cancer, varies greatly.
- Nail clubbing is often seen with a serious underlying illness.
- Lung cancer is the most common cause of clubbing in adults.
- Clubbing affects only a small portion of lung cancer patients (5% to 15%).
- The presence of clubbing in people with other diseases varies.
People with nail clubbing may also have hypertrophic osteoarthropathy, a condition where new soft bone forms at the ends of long bones like the radius, ulna, tibia, and fibula. This condition is often seen in people with clubbing, particularly those who have bronchogenic carcinoma (a type of lung cancer), other thoracic cancers, and cystic fibrosis.
Signs and Symptoms of Nail Clubbing
Nail clubbing is a condition that can be detected during a physical examination. It’s important to know that although nail clubbing often indicates an underlying health issue, not everyone with a medical condition gets clubbing. Also, clubbing can look different from person to person. However, it’s critical to identify a patient’s symptoms to accurately determine the cause of nail clubbing, though sometimes it can be hard to identify, especially when it’s not severe.
Various methods are used to assess nail clubbing:
- Lovibond Angle: Also known as the profile sign, it looks at the angle where the nail comes out from the nail fold. If this angle is greater than 180 degrees, it can signify clubbing.
- Hyponychial Angle: This examination involves drawing two lines – one from the cuticle to the crease at the tip of the finger and another from the under nail area to the cuticle. If the angle is less than 192 degrees, it is considered normal.
- Phalangeal Depth Ratio: This is the comparison of the depth of the finger at the nail and at the joint nearest the nail. Clubbing is suggested when the finger depth at the nail is larger than at the joint.
- Schamroth sign: It was discovered by Schamroth in 1976. Normally, when you put the same fingers of each hand together, a diamond-shaped space is formed. In clubbed fingers, this space disappears, which is now known as the Schamroth sign.
- Nail Cuticle Angle: The change in this angle can be the most telling sign of clubbing.
Interestingly, clubbing can develop quickly, often within two weeks, like in patients with new-onset empyema, a type of lung infection. Equally, it can also disappear quickly, often within two weeks, for example in cases following corrective heart surgery.
Testing for Nail Clubbing
If your doctor suspects that your nails are clubbed, they start by asking you about your medical history and any symptoms you might have, especially looking for features that might point to the cause of the nail clubbing. After that, they would do a physical examination of your nails, assessing their appearance and measurements. Nail clubbing is often linked with lung or heart conditions, so it’s sensible for the doctor to conduct a chest x-ray. If no issues are visible on the x-ray, the next step would be a CT (Computerized Tomography) scan to look for any signs of early-stage lung cancer or other diseases that could potentially be treated.
Treatment Options for Nail Clubbing
Treatment for nail clubbing doesn’t focus on the clubbing (unusual curvature and enlargement of the fingernails or toenails) itself, but rather the underlying health condition causing it. How well treatment works can vary greatly depending on the specific health problem causing the clubbing.
There isn’t a lot of information on whether clubbing can be reversed. However, there have been reports of clubbing going away, especially in patients who developed it due to prostaglandin therapy (a type of medicine) for liver disease. In these cases, the clubbing reversed when the therapy was stopped.
What else can Nail Clubbing be?
Nail clubbing, which is a thickening of tissue under the nails that causes them to curve, can be a result of many different diseases. This means that doctors have to look at many possibilities when trying to find the cause of this condition. Here are some of the things that may cause it:
- Different types of lung or chest diseases, including lung cancer, lung abscess, and bronchiectasis.
- Certain types of heart disease, such as congenital heart disease and endocarditis, an infection of the heart’s inner lining.
- Diseases in the digestive system like inflammatory bowel disease and celiac disease.
- Liver diseases, like biliary cirrhosis and juvenile cirrhosis.
- Metabolic diseases, which are conditions that change the way the body converts food into energy, such as thyroid acropathy and severe secondary hyperparathyroidism.
- Some medications, like laxatives, can also lead to nail clubbing if used excessively.
It’s important for doctors to carefully consider all of these possibilities when diagnosing this condition, to ensure they find the most effective treatment possible.
What to expect with Nail Clubbing
The outcome of treating and managing nail clubbing, a condition where the ends of your fingers swell and the nails curve around your fingertips, heavily depends on the cause of the condition. If the cause can be treated or cured, the clubbing will likely disappear. On the other hand, if the cause is a long-term condition or cancer, the clubbing is likely to persist over time.
Possible Complications When Diagnosed with Nail Clubbing
Clubbing can cause changes in a person’s appearance, which may lead to challenges in daily life, especially related to psychosocial aspects. There is limited information available, but some reports suggest that acquired clubbing can be reversed by successfully treating the condition that caused it.
It’s important to understand the cause of clubbing because if the underlying condition isn’t treated, it could lead to further complications.
Key Points:
- Clubbing can impact a person’s appearance, possibly causing challenges in everyday life.
- Reports suggest that treating the underlying cause can reverse acquired clubbing.
- Understanding the cause of clubbing is crucial to avoid further complications from the untreated underlying condition.
Preventing Nail Clubbing
Generally, patients find it very helpful when healthcare professionals provide them with lots of details about their health conditions. This is true for all sorts of medical issues, including something known as “clubbing.” Clubbing refers to physical changes in the areas of your body like your fingers and toes where your nails are. It’s important for patients to ask questions and learn more about their condition. Whenever it’s suitable, healthcare providers should reassure patients, particularly if their clubbing isn’t tied to any serious underlying health problems.