Nail Clubbing

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Clubbing of Nail/Hippocratic nails

Bulbous enlargement of distal aspect of toes and fingers – increased bilateral curvature of nail plate.
Proximal phalanx is normal.
Increased vascularity in early stages  ‘spongy’ feeling on pressing base of nail.
80% associated with respiratory abnormalities – mostly bronchiectaisis and bronchitis

Grade 1 nail fold filled
Grade 2 beaking of nail
Grade 3 increased toe pulp in dorsal-plantar direction
Grade 4 increased lateral bulk

Lovibond’s lateral profile sign – used to measure the longitudinal angle between the curved nail plate and the proximal nail fold – normally 160°, but in clubbing it exceeds 180°
Curth’s modified profile sign – angle between distal and middle phalanges – normally 180°, but in clubbing it is reduced.

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