Tuberous nails: definition, causes and diagnosis.


Toenail is a change in the structure of the fingernails or toenails in which the finger and toenail look like an inverted spoon and become red and fluffy. It can occur on its own or with other symptoms such as shortness of breath or cough.

There are several possible causes, including lung disease, heart disease, and digestive tract disease, although about 90% of cases are associated with lung cancer. Clubbing can also be a normal inherited trait.

Diagnosis is made primarily by looking at the fingers and most often alerts the healthcare provider to additional tests such as computed tomography (CT) of the chest and more. Treatment will depend on the underlying cause of the cane.

James Heilmann / Wikimedia Commons


Clubbing is a condition first described by Hippocrates in which the fingers (and / or toes) appear as inverted spoons. It is caused by a build-up of tissue on the distal part of the fingers (terminal phalanges), causing the tips of the fingers to enlarge and the nails to bend downward.

In addition to changing the angle of the nail and nail bed, nails can become fluffy and soft and have a reddish tint. Finger "growth" appears to occur on both sides; laterally and longitudinally; lengthwise on the fingers .

Clubbing most often happens gradually, but for some people it can happen quite quickly. In people with a secondary glomerulus, the symptom may go away after successfully treating the underlying cause.

The medical term used to describe clubbing is hypertrophic osteoarthropathy.


Although many healthcare professionals think of pulmonary causes first, when they come across people with clogged nails, there are several potential causes. They are divided into several categories:

Idiopathic – This is a category where clubbing happens for no apparent reason and doesn't cause any medical problems – they just do.

Inherited trait : There are several ways to inherit nightclubs. Most of the time, this trait is inherited in an autosomal dominant manner, which means that if one of your parents is a carrier of the trait, there is a 50:50 chance that you will inherit the trait as well.

Secondary club :   A secondary club is a club that occurs in connection with a disease. Conditions commonly associated with clubs include:

  • Lung Cancer : Entanglement is a symptom found in about 29 percent of people with lung cancer and is the most common cause of club blow (about 90 percent of cases). It is much more common in non-small cell lung cancer than in small cell lung cancer.
  • Other types of cancer : Other types of cancer, especially Hodgkin's disease , can manifest themselves with the baton.
  • Lung disease: Some lung diseases associated with clubbing include bronchiectasis , interstitial lung diseases such as idiopathic pulmonary fibrosis , empyema , pulmonary tuberculosis, and cystic fibrosis.
  • Congenital heart disease : Heart disease that is present from birth, especially "cyanotic heart disease" such as tetralogy of Fallot, is often accompanied by clubbing.
  • Gastrointestinal disorders: Some conditions in this category associated with clubbing include gluten sprue, cirrhosis, Crohn's disease, and ulcerative colitis.
  • Endocrine problems : hyperthyroidism, especially Graves' disease, can be accompanied by a club.

The process underlying the club's activities is not yet understood. Scientists believe this may be due to platelet growth factor and vascular endothelial growth factor, although the exact mechanism is unknown.

No one knows exactly why the club is happening, and there are probably several mechanisms. It is believed that for many people the widening of the blood vessels in the distant regions of the fingers leads to the formation of connective tissue, which leads to the appearance of clubs, but there are probably many different reasons why this happens.


Most of the time, a ball is seen on physical exam and is expected to be based on other findings (such as the presence of lung disease or cancer).

The clubs are usually obvious, but if they are subtle, other inferences and measurements can be made to confirm the diagnosis. This includes:

  • Lovibond angle: the angle between the base of the nail and the nail itself.
  • Distal / interphalangeal depth ratio
  • Chamroth's sign: No window (space) between the fingers, when the fingers of each hand are placed together and the tops of both hands are touched.

Differential diagnosis : Chronic kidney disease and other conditions, such as systemic sclerosis, can cause changes in the fingers that mimic the bumps on the fingers.

Diagnostic tests to identify the causes of clubs.

If your healthcare provider notices that you have clubs, or if they tell your doctor, the first thing they will do is ask about your family history to determine if it could be an inherited trait. The healthcare professional will then closely examine the medical history and perform a physical examination, considering possible causes associated with secondary hypocrisy.

Some tests, depending on your symptoms, may include:

  • A chest X-ray and possibly a chest CT scan to check for lung cancer and other diseases of the lungs and heart.
  • An electrocardiogram (ECG) and / or echocardiogram to evaluate your heart.
  • Arterial blood gases and / or pulmonary function tests to assess lung function and identify underlying lung conditions.
  • Blood tests, such as liver function tests and thyroid function tests.

Watch out

There is no specific treatment, including clubbing surgery. Treating the root cause with a cane can make it go away in some people; for example, in people with heart valve defects, they can go away after successful surgery.

Frequently asked questions

What angle is considered a nail?

If the angle between the base of the nail and the nail itself is greater than 180 degrees, it is considered a stick. Between 160 and 180 degrees, there may be an early party stage.

Which doctor should you go to to evaluate your nail clubs?

You can speak with your PCP or a board-certified dermatologist to help you assess for nail tangles and refer you to a specialist if necessary.

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