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