Clubbing
Clubbing is the selective bulbous enlargement of the distal segments of fingers or toes due to proliferation of connective tissues (Fig. 10).
Figure 10 Clubbing.
Note the exaggerated longitudinal curvature and the loss of angle between the nail and the nailbed.
History
A systematic approach to the history is required to determine the cause of clubbing. Respiratory, cardiovascular and gastrointestinal system enquiries should be made in an attempt to determine the underlying cause. A detailed discussion on the diagnosis of congenital cyanotic heart disease (tetralogy of Fallot, transposition of great arteries, total anomalous pulmonary venous drainage) is beyond the scope of this text.
Duration
The duration of clubbing may give an indication of the underlying aetiology. Clubbing present since infancy would suggest a familial trait or congenital cyanotic heart disease. Alternatively, it may be a secondary manifestation of hereditary disorders such as coeliac disease and cystic fibrosis.
