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The clinical approach to clubbing involves being certain that clubbing is present. A curved fingernail is not good evidence, and the “drumstick” appearance (which makes the finger look like a true club) does not occur until late. Early clubbing is determined by the angle between the nail-covered portion of the dorsal surface of the terminal phalanx and the skin-covered portion. Normally this angle is 160 degrees. When the angle becomes 180 degrees and disappears, that is, when the terminal phalanx becomes flat, clubbing exists.
Careful examination for cyanosis and a thorough evaluation of the heart and lungs will determine the cause in most cases. Pulmonary function studies, and arterial blood gases before and after exercise and before and after 100% oxygen, will help confirm the diagnosis in many cases. Of course, lung scans and angiocardiography are frequently necessary. Blood cultures, stool culture and examination, and thorough radiologic studies of the GI tract will be necessary in obscure cases.
Source: Differential Diagnosis in Primary Care, 2007
The clinical approach to clubbing involves being certain that clubbing is present. A curved fingernail is not good evidence, and the “drumstick” appearance (which makes the finger look like a true club) does not occur until late. Early clubbing is determined by the angle between the nail-covered portion and the skin-covered portion of the dorsal surface of the terminal phalanx. Normally this angle is 160 degrees. When the angle becomes 180 degrees and disappears, that is, when the terminal phalanx becomes flat, clubbing exists. Careful examination for cyanosis and a thorough evaluation of the heart and lungs will determine the cause in most cases. Pulmonary function studies, and arterial blood gases before and after exercise and before and after 100% oxygen, will help confirm the diagnosis in many cases. Of course, lung scans and angiocardiography are frequently necessary. Blood cultures, stool culture and examination, and thorough radiologic studies of the gastrointestinal tract will be necessary in obscure cases.
Source: Differential Diagnosis in Primary Care, 2007
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