Clubbing of fingers

The term clubbed fingers is used to describe a relatively rare deformity in which the fingertips look like tiny clubs. The fingernails curve downward and the tips become bulb-shaped and somewhat flattened. In severe cases, the cuticles seem to disappear and the fingertips look something like an overturned spoon or a spatula.

In some instances, the oddly shaped fingers may be due to an inherited trait, but more often, the clubbing is a symptom of a serious lung or heart disease. Sometimes the toes also may be affected. What actually causes the clubbing is unknown, but if your fingertips begin to take on this unusual appearance, you should see your doctor for a complete checkup to rule out a serious underlying medical problem.

Causes of clubbing of fingers

Aortic valve disease
Blood that is pumped from the heart to circulate through the body passes from the left ventricle (the heart's main pumping chamber) through the aortic valve and into the aorta, the body's largest artery which branches off into smaller blood vessels. If the aortic valve becomes diseased and unable to allow enough blood to pass through it, aortic insufficiency results. The problem may be congenital, or it may be due to rheumatic fever, infection, or other diseases. Symptoms include shortness of breath, fatigue, chest pains, and clubbing of fingers.

Arthritis
Arthritis in the first finger joint can deform the tip, giving the fingers a clubbed appearance. Heberden's nodes, a type of osteoarthritis that causes enlargement of the first finger joint, is the most common example. Strictly speaking, the finger deformity caused by Heberden's nodes is not true clubbing of the fingers, but the appearance may be similar.

Bronchiectasis
This disease often follows a severe bronchial infection or pneumonia and is characterized by infection and abnormal dilation of the bronchi. The air passages become inflamed, causing increased mucus production and progressive destruction of lung tissue. Symptoms may be similar to those of chronic bronchitis, including clubbed fingers in advanced or persistent cases. Antibiotics usually clear up the infection, but there may be permanent lung damage.

Chronic bronchitis
In bronchitis, the tubes that carry air from the windpipe to the lungs (bronchi) become inflamed and congested. When the condition persists for several months, the bronchitis is considered chronic. Symptoms include coughing, wheezing, and production of large amounts of phlegm; in long-standing cases, the fingers also may become clubbed.

Congestive heart failure
Congestive heart failure occurs when the heart is unable to fully perform its pumping function. The blood backs up into the lungs, causing them to become congested with excess fluid. Shortness of breath, swelling (edema), and clubbing of fingers all are signs of possible congestive heart failure.

Cystic fibrosis
Cystic fibrosis is a serious genetic disease in which the body's secretions are abnormally thick and profuse. Many organs are affected, but the lungs are particularly vulnerable. They become filled with thick mucus, which makes breathing difficult and also increases the likelihood of infection. Clubbed fingers are common in advanced cystic fibrosis.

Emphysema
This disease is characterized by progressive loss of elasticity of the air sacs (alveoli). The person can breathe in fresh air but is unable to fully exhale. As a result, stale air becomes trapped in the lungs and the body suffers from a lack of oxygen. In addition to clubbing of fingers, symptoms of advanced emphysema include shortness of breath, fatigue, and development of a distended, barrel-shaped chest.

Tuberculosis
At the turn of the century, tuberculosis — or consumption as it was commonly called—was our leading cause of death. Today, this infectious lung disease is relatively rare, thanks to antibiotics that can kill the causative bacteria. But even though tuberculosis is no longer a major cause of death in this country, there has been a recent resurgence of the disease, especially among the homeless and drug abusers. Symptoms include a chronic cough that produces blood-specked phlegm, weight loss, shortness of breath, pain upon taking a deep breath, and, as the disease progresses, clubbing of the fingers.

Advice about clubbing of fingers

  • Sometimes clubbing of fingers may be a family characteristic. If other members of your family have flat, oddly curved fingertips and are healthy, chances are you have inherited the finger shape and are not suffering from a serious disease.
  • Swollen or deformed fingertips from Heberden's nodes, a type of osteoarthritis, is not a serious disorder. At first, there may be some pain and inflammation, but this usually subsides and there are no further problems.

 

This article was last reviewed October 17, 2005 by Dr. James Krider.
Reproduced in part with permission of Home Health Handbook.


Aortic valve disease
Arthritis, degenerative
Bronchiectasis
Bronchitis, chronic
Congestive heart failure
Cystic fibrosis
Emphysema
Tuberculosis

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