Tips on Clubbing

s classified into five phases:

nPhase I   - increase swaftening and fluctuation of the ungua bed;

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nPhase II    - loss of the natural 15° angle between the nail and cuticle;

nPhase III   - increased convexity of the ungual bed;

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nPhase IV   - clubbed appearance of the digital extremity;   drumstick appearance

nPhase V     - increase of the extremity, with thickening of  the distal phalange and longitudinal striations on the fingernail.

n The specific pathophysiologic mechanism of digital clubbing remains unknown. Many theories have been proposed, yet none have received widespread acceptance as a comprehensive explanation for the phenomenon of digital clubbing.

n  As stated best by Samuel West in 1897, "Clubbing is one of those phenomena with which we are all so familiar that we appear to know more about it than we really do.

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n Theories suggested for the pathogenesis of Hypertrophic osteoarthropathy & clubbing

1.   Neurogenic

2.   Humoral

3.   Role of megakaryocytes and large platelet particles

4.   Genetic & familial

5.   Hypoxia