DIGITAL CLUBBING IN PEDIATRIC AGE

GROUP

By Dr. Deboprasad Das

CRITERION FOR CLUBBING

A finger can be called as clubbed finger when:

1. lovibond angle > 180 degrees

2. Schamroth sign is positive

3. phalangeal depth ratio > 1

LOVIBOND ANGLE

The angle between the nail bed and the nail is known as Lovibond angle. Normally its an acute angle

In clubbing the lovibond angle is >180degrees

LOVIBOND ANGLE

SCHAMROTH SIGN

When the distal phalanges (bones nearest the fingertips) of corresponding fingers of opposite hands are directly opposed (place fingernails of same finger on opposite hands against each other, nail to nail), a small diamond-shaped "window" is normally apparent between the nailbeds. If this window is obliterated, the test is positive and clubbing is present.

Dr. Schamroth demonstrated it first in his own finger

SCHAMROTH’S SIGN

PHALANGEAL DEPTH RATIO

In a normal finger the Inter phalangeal Depth (IPD) is more than the Distal phalangeal Depth(DPD)

In clubbing DPD/IPD>1

DPD:IPD>1

TYPES OF CLUBBING

Unilateral or bilateral

Primary or secondary

Acute or chronic

ACUTE CLUBBING

Acute clubbing develops within 2-3 weeks.

Mostly seen in: Suppurative lung disorders(in lung abscess clubbing can be seen in 10-14days)

Mesothelioma

Bacterial endocarditis

CHRONIC CLUBBING

Chronic clubbing develops in about 6 months as in cyanotic heart diseases such as Tetralogy of Fallot.

In bronchiectasis clubbing may take upto 1year to develop

PRIMARY FORM OF CLUBBING

Primary form of clubbing is generally idiopathic or hereditary.

Pachydermopriostosis contributes to about 85% of primary form of clubbing.

SECONDARY FORM OF CLUBBING

Secondary form of clubbing is mostly secondary to systemic illness affecting mainly respiratory system, cardiovascular system, hepatobiliary system and gastrointestinal system, and hence is bilateral in general.

Suppurative:

Bronchiectasis

Lung abscess

Empyema

Pulmonary TB

RESPIRATORY SYSTEM DISEASES ASSOCIATED WITH

CLUBBING

Neoplastic:

Bronchial adenoma

Mesothelioma

Bronchogenic carcinoma(common in adults)

Cyanotic congenital heart diseases: Tetralogy of Fallot

Transposition of Great Cardiac vessels

Ventricular Septal Defects

Ebstein anomaly

CARDIOVASCULAR DISEASES

Bacterial endocarditis

Atrial myxomas

Chronic congestive heart failure

GASTROINTESTINAL DISEASES

Cirrhosis

Malabsorption syndrome

Intestinal polyposis

Inflammatory bowel disease(ulcerative colitis and Crohn’s disease)

ENDOCRINE DISEASES

Myxoedema

Thyrotoxicosis

DIFFERENTIAL CLUBBING

It refers to clubbing with cyanosis limited to either upper or lower limbs.

Clubbing with cyanosis limited to lower limb is seen in Patent Ductus Arteriosus with a reversed shunt

Clubbing with cyanosis limited to upper limb is seen in Transposition of great vessels with PDA with reverse shunt.

PSEUDOCLUBBING

As the name suggests, it refers to appearance of clubbing without actual presence of it, seen in:

Hyperparathyroidism: there is excessive resorption of distal phalanges

Hansen’s disease

Leukemia: bone destruction due to secondary deposits

Thank you