Transcript By Dr. Deboprasad Das

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.
RESPIRATORY SYSTEM
DISEASES ASSOCIATED
WITH CLUBBING
 Suppurative:
 Neoplastic:
Bronchiectasis
Bronchial adenoma
Lung abscess
Mesothelioma
Empyema
Bronchogenic
Pulmonary TB
carcinoma(common in adults)
CARDIOVASCULAR
DISEASES
 Cyanotic congenital heart
 Bacterial endocarditis
diseases: Tetralogy of Fallot
 Atrial myxomas
Transposition of
Great Cardiac vessels
Ventricular Septal
Defects
Ebstein anomaly
 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