COPD An Overview of Clubbing of the Fingers This finger deformity can be a sign of lung disease By Deborah Leader, RN Deborah Leader RN, PHN, is a registered nurse and medical writer who focuses on COPD. Learn about our editorial process Deborah Leader, RN Medically reviewed by Medically reviewed by Sanja Jelic, MD on November 27, 2019 Sanja Jelic, MD, is board-certified in sleep medicine, critical care medicine, pulmonary disease, and internal medicine. Learn about our Medical Review Board Sanja Jelic, MD Updated on January 29, 2020 Print Table of Contents View All Table of Contents Symptoms Causes Diagnosis Treatment Clubbing of the fingers, also described as hypertrophic osteoarthropathy (HOA), is an enlargement of the ends of the fingers accompanied by a downward sloping of the nails. You can have primary HOA, which is simply a clubbed appearance of your fingers that is not associated with any health problems. Or you can develop secondary clubbing, which is caused by health problems such as lung cancer and heart disease. This photo contains content that some people may find graphic or disturbing. See Photo Desherinka / WIkimedia Commons / CC BY-SA 4.0 The clubbing itself is not harmful, but since it can be a sign of disease, it is important that your medical team identifies the cause and that you are treated for your underlying condition. Also Known As Clubbing is also referred to as clubbed fingers, digital clubbing, watch-glass nails, drumstick fingers, Hippocratic fingers, Hippocratic nails. Verywell/Jessica Olah Symptoms Clubbing can involve your fingers and/or toes. It is typically bilateral (affecting both hands and/or feet) and it should be equal in terms of its extent on both sides. If you or your child has primary HOA, then your fingers or toes may naturally appear large, bulging, and rounded. This will be noticeable during childhood or during the teenage years, and it will not change much over time. With primary HOA, other family members are also likely to have finger and/or toe clubbing. Secondary clubbing happens gradually, and it causes a change in the appearance of your fingers and/or toes. With secondary clubbing, which is caused by disease, you would also have other features that are not seen in primary clubbing. Features of secondary clubbing include: Softening of the nailsNail beds that soften and feel spongyNails that seem to "float" instead of being firmly attached to your fingersDisappearing of the angle between your nails and cuticleEnlargement or bulging of the distal portion of your finger (where your finger meets your nail)Warm, red nail bedsNails that curve downward and look like the bottom of the round part of a spoon Eventually, the nail and skin around the nail may become shiny, and the nail develops ridging. Causes Primary clubbing is hereditary, and it is passed down via genes. Hereditary clubbing is simply a physical feature, like the color of your eyes or your height. Several genes have been associated with primary clubbing, including the HPGD gene and the SLCO2A1 gene. Secondary clubbing occurs as one of the effects of chronic lung and heart disease. Lung cancer is the most common cause of clubbing. This sign is also associated with a number of other chronic illnesses, including conditions that involve the thyroid gland or the digestive system. There are a number of health risk factors associated with secondary clubbing, including: Lung cancerInterstitial pulmonary fibrosisLung abscessPulmonary tuberculosisPulmonary lymphomaCongestive heart failureInfective endocarditisCyanotic congenital heart diseaseBronchiectasisCystic fibrosisOther types of cancer, including liver, gastrointestinal or Hodgkin lymphomaInflammatory bowel diseaseLiver cirrhosisGastrointestinal neoplasmsCeliac diseaseDysenteryGraves' diseaseAn overactive thyroid gland How Disease Affects Nail Beds The medical conditions that can cause clubbing are generally associated with decreased oxygen levels. Experts suggest that clubbing occurs as your body undergoes changes in response to low oxygen. Several processes affect the nail beds in secondary clubbing. The nail enlargement occurs due to the growth of excess soft tissue beneath the nail beds. The enlargement is associated with inflammation and a proliferation of small blood vessels in the nail beds. A protein called vascular endothelial growth factor stimulates the growth of blood vessels, and this protein is considered a major factor in the physical changes that occur in clubbing. Common Complications of COPD Diagnosis Clubbing can be subtle, so it may be difficult for you and your medical team to verify this change in your digits. There are a few objective criteria that are used to assess clubbing, and they can help in determining whether you have developed this physical change: Lovibond's profile sign: Normally, there is a sharp angle between the nail bed and the cuticle. When you have clubbing, the natural angle is lost as the nail angles down instead of up.Distal/interphalangeal depth ratio: The phalanges of your finger are the sections between each bending joint. Your distal phalange, the one that includes your nail, is normally shorter depth-wise than the neighboring phalange. Clubbing is indicated when the opposite is true.Schamroth's sign: The sharp angle between your nail bed and cuticle forms a tiny diamond-shaped hole when you place your hands together with the top of your nails facing each other. When this gap disappears, it is described as Schamroth's sign. Assessing Underlying Conditions Often, clubbing develops due to a chronic medical condition that was diagnosed years before the clubbing developed. When you start to have clubbing of your digits, your medical team will evaluate you to identify any underlying disease that could be causing it. Even if you have an established lung or heart condition, your medical team will assess your condition to identify any progression that could require an adjustment of your treatment. Tests that you may need in the evaluation of clubbing include: A physical examination to assess for signs such as weight loss, difficulty breathing, skin changes, alterations in your pulse, or altered blood pressureA pulse oximeter to measure your blood oxygen levelPulmonary function tests (PFTs)Arterial blood gas testChest imaging tests, such as chest X-ray or chest computerized tomography (CT)Blood tests, including complete blood count (CBC), electrolyte levels, liver function tests (LFTs), and/or thyroid testsAn electrocardiogram (EKG) or echocardiogram to assess your heart functionAbdominal imaging tests such as CT or ultrasoundA biopsy if there is a concerning lesion noted on an imaging test How Lung Cancer Is Diagnosed Treatment Usually, the abnormal shape and size of the digits do not cause health problems, but any underlying disease that causes clubbing needs to be medically and/or surgically managed, as appropriate. Treatments may prevent your clubbing from worsening and, in rare cases, can reverse some or all of the physical features of clubbing. There are a variety of approaches used to treat the underlying cause of clubbing. Your treatment will depend on your situation. You may need management of respiratory disease, treatment of heart disease, or interventional therapy for cancer. Treatments may include: Anti-inflammatory treatment for inflammatory conditions, including some pulmonary and gastrointestinal diseasesHormone replacementPacemaker implantation to improve heart function A Word From Verywell If you notice that your fingers are clubbing, be sure to discuss this with your doctor. Clubbing can be diagnosed in your doctor's office. Although clubbing itself is harmless and doesn't require treatment, it is often associated with health conditions that can worsen without treatment. Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Krugh M, Vaidya PN. Osteoarthropathy Hypertrophic. In: StatPearls. Treasure Island, FL: StatPearls Publishing, 2019. Yuan L, Liao RX, Lin YY, et al. Safety and efficacy of cyclooxygenase-2 inhibition for treatment of primary hypertrophic osteoarthropathy: A single-arm intervention trial. J Orthop Translat. 2019;18:109-118. doi:10.1016/j.jot.2018.10.001 Chakraborty RK, Sharma S. Secondary hypertrophic osteoarthropathy. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2019. Callemeyn J, Van Haecke P, Peetermans WE, Blockmans D. Clubbing and hypertrophic osteoarthropathy: insights in diagnosis, pathophysiology, and clinical significance. Acta Clin Belg. 2016;71(3):123-30. doi:10.1080/17843286.2016.1152672