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Finger Clubbing

Clubbing of the finger and fingernail is an abnormal axial convex curved shape with enlargement of the distal finger and nail and loss of the angle at the nail fold. Clubbing of the fingers may be associated with an underlying pulmonary disease, as in cyanotic congenital heart disease, cystic fibrosis, and bronchial carcinoma. However, it can also be seen in Crohn disease, cirrhosis, and thyrotoxicosis. Finger clubbing can be an important clinical sign in the progress of a disease. Inherited differences in finger shape can also resemble pathological clubbing, but the angle at the proximal nail fold is intact. The degree of clubbing can be recorded in photographs taken from the side of the finger. A lateral photograph of the index finger will document the proximal nail fold, cuticle, and nail, as well as the curve of the nail itself (Fig. 11.9).

Figure 11.9 Schematic diagram of finger clubbing.

Figure 11.9 Schematic diagram of finger clubbing.

Normal nail

True clubbing

Familial pseudo clubbing

Normal nail

True clubbing

Familial pseudo clubbing

Method to Estimate Nail Growth

Growth of a nail can be followed by marking an area of the nail with silver nitrate or by punching or cutting a hole or mark into the nail (nail plate) itself and measuring the distance from the cuticle over a period of time (see Bibliography).

The average thumbnail takes 150 days to grow from its cuticle to the free edge of the nail. The average rate of nail growth is between 0.10 and 0.123 mm/day. The nails of children grow faster than those of adults, and the rate varies with the season being slightly more rapid in the summer.

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