Clubbing of the Nails

Image: Wikipedia

Image: Wikipedia

Part of the standard cardiovascular or respiratory examination involves the physician inspecting the hands, fingers and fingertips/nails of the patient. One of the signs that they are looking for is clubbing of the nails.

This is a very specific physical symptom associated with a wide range of conditions, although approximately 60% of cases are not associated with any underlying pathology.

Clubbing is present when the angle of the nail bed is over 160 degrees. This is commonly tested by putting fingers of opposite hands nail to nail and observing the normal diamond shape between the nails. If this is absent, clubbing may be present.

Condition associated with clubbing of the nails

Respiratory System

  • Bronchial carcinoma
  • Chronic suppurtive lung disease
    • bronchiectasis – abnormal widening of one or more airways
    • lung abcess
    • empyema – collection of pus within pleura, following pneumonia
  • Pulmonary fibrosis
    • idiopathic lung fibrosis
  • Pleural & mediastinal tumours
    • mesothelioma – rare cancer following exposure to asbestos
  • Cryptogenic organizing pneumonia (COP) / Bronchiolitis obliterans organizing pneumonia (BOOP)
    • inflammation of bronchioles and surrounding tissues

Cardiovascular System

  • Cyanotic heart disease
    • patient appears blue as de-oxygenated blood bypasses the lungs and passes straight into systemic circulation
  • Subacute infective endocarditis
    • inflammation of endocardium, usually involving heart valves
    • caused by bacteria or other organisms
    • accompaied with Osler’s Nodes
  • Atrial myxoma
    • non-cancerous tumour of atrial septum


  • Cirrhosis
    • scarring of the liver, can be caused by long term alcohol abuse or Hepatitis B or C
  • Inflammatory Bowel Disease
  • Congenital – no disease (60% of cases)

If you are concerned about anything mentioned in this article, seek professional advice by visiting your GP who will be able to talk to you about your concerns.

Ref: Kumar, P & Clark, M (2009). Clinical Medicine. 7th ed. Edinburgh: Saunders Elsevier. p820.

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