Finger Clubbing: Causes and When to Seek Help for Clubbing of Fingers

Medically Reviewed By Angelica Balingit, MD
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Finger clubbing is a thickening of the fingertips that gives them an abnormal, rounded appearance. The exact cause of finger clubbing is not known, but it is a common symptom of respiratory disease, congenital heart disease, and gastrointestinal disorders. This article will explain what causes finger clubbing, when you should contact a doctor for clubbing of the fingers, and more.

What causes finger clubbing?

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There are many possible causes of finger clubbing. These can be linked to the lungs, heart, intestines, or other parts and processes of the body.

Respiratory causes of finger clubbing

Finger clubbing may be caused by respiratory diseases, including:

Cardiac causes of finger clubbing

Finger clubbing can also be due to cardiac diseases, including:

  • endocarditis
  • atrial myxoma (tumor arising within the heart)
  • total anomalous pulmonary venous return (TAPVR is a rare condition in which the pulmonary veins do not empty into the heart)
  • transposition of the great vessels (rare condition in which the major vessels entering or leaving the heart are misconnected

Gastrointestinal causes of finger clubbing

Finger clubbing can also be caused by gastrointestinal diseases, including:

Other causes of finger clubbing

Finger clubbing can also have other causes, including:

Questions for diagnosing the cause of finger clubbing

To diagnose your condition, your doctor or healthcare professional will ask you several questions related to your finger clubbing, including:

  • Do you have any other symptoms?
  • Do you have difficulty breathing?
  • What medications are you taking?
  • When did you first notice finger clubbing?

What are the stages of finger clubbing?

Doctors label four grades of finger clubbing:

Grade 1: Nail bed fluctuation.
Grade 2: Obliteration of the Lovibond angle.
Grade 3: Parrot beaking.
Grade 4: Hypertrophic osteoarthropathy (HOA).

A person with finger clubbing may notice these stages develop in the following ways:

  1. The nail bed becomes softer while the skin surrounding the nail becomes discolored or redder.
  2. The nail curves more than usual because the angle between the nail bed and the skin just below the cuticle gets bigger.
  3. The nail and the skin around the nail begin to appear shiny. It may also appear as though the nail has ridges going across it lengthways.
  4. Finally, the ends of the fingers may start to look bigger.

Hypertrophic pulmonary osteoarthropathy (HPOA)

Some people find extra areas of bone begin to form on their finger joints, wrists, and ankles. This can happen during the later stages of finger clubbing. People may mistake this for certain types of swelling or arthritis.

What are the potential complications of finger clubbing?

Because finger clubbing can be due to serious diseases that cause cyanosis, not seeking treatment can result in serious complications and permanent damage.

Once the underlying cause is diagnosed, it is important for you to follow your treatment plan to reduce the risk of potential complications, including:

  • heart failure
  • long-term physical disability
  • organ failure or dysfunction
  • respiratory failure
  • spread of cancer
  • spread of infection

How is finger clubbing treated?

The treatment for finger clubbing will depend on its cause. Learn more by viewing our articles here:

Always contact a doctor to determine the best treatment option for you.

Learn about foods that help ease pregnancy symptoms here.

When should you seek medical help for finger clubbing?

Always contact a doctor if you notice new symptoms, such as possible early stages of finger clubbing, that concern you.

Seek prompt medical care if you are being treated for finger clubbing but mild symptoms recur or are persistent.

In some cases, finger clubbing can be a symptom of a life threatening condition. Seek immediate medical care (call 911) if you, or someone you are with, have any of these symptoms, including:

  • bluish coloration of the lips or fingernails
  • change in a level of consciousness or alertness
  • rapid heart rate
  • respiratory or breathing problems, such as: 
  • wheezing, not breathing, or choking

You should also receive medical treatment and testing, including an urgent chest X-ray, if you have finger clubbing and:

  • are over 40
  • have two or more of the above symptoms including breathlessness, or
  • have one symptom and have never smoked

How do you examine finger clubbing?

You can examine finger clubbing by measuring the angle between the base of the nail and the nail bed. This is called the Lovibond angle.

Doctors may ask you to show them your finger at different angles and in relation to your other fingers so they can examine angles called the hyponychial angle and the phalangeal depth ratio.

They may also use the Schamroth sign, which involves a person placing the nails of the same finger but on opposite hands together, with the joints of those fingers closest to the nails touching too. In people without finger clubbing, there is usually a diamond-shaped gap between the two fingers around the nail bed. This is a negative, or normal, Schamroth sign.

In people with clubbed fingers, there is no diamond shape. The fingers may be completely flush together at the nail bed and the end of the nails may curve away from each other. This is a positive Schamroth sign.

Summary

Respiratory diseases associated with finger clubbing include chronic obstructive pulmonary disease (COPD), lung cancer, cystic fibrosis (thick mucus in the throat and digestive tract), and bronchiectasis (destruction of the large airways).

Congenital heart diseases (heart diseases present since birth) that lead to finger clubbing are typically cyanotic, meaning that they cause a person to appear blue due to reduced oxygen in the blood. Clubbing can happen in pregnancy and acromegaly (gigantism due to a pituitary tumor).

Gastrointestinal disorders that can lead to clubbing of the fingers include celiac diseaseCrohn’s disease, inflammatory bowel disease, and liver disease, especially in severe cases, such as cirrhosis of the liver.

Other diseases associated with finger clubbing include Hodgkin’s lymphoma and Graves’ disease (thyroid condition).

Clubbing may be accompanied by cyanosis (blue coloration of the skin) and shortness of breath.

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Medical Reviewer: Angelica Balingit, MD
Last Review Date: 2022 Sep 7
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