Clubbing and hypertrophic osteoarthropathy: insights in diagnosis, pathophysiology, and clinical significance

Acta Clin Belg. 2016 Jun;71(3):123-30. doi: 10.1080/17843286.2016.1152672. Epub 2016 Apr 22.


Background: Digital clubbing and hypertrophic osteoarthropathy (HOA) form a diagnostic challenge. Subtle presentations of clubbing are often missed. The underlying pathophysiology remains unclear. Establishing a differential diagnosis based on nonspecific signs can be cumbersome. Finally, the prognostic value of clubbing and HOA remains unclear.

Objective: This article reviews clinical criteria and pathophysiology of clubbing and HOA. A diagnostic algorithm is proposed, based on etiology and current insights. The prognostic impact on associated diseases is discussed.

Methods: The Internet databases Medline and Embase were searched. Articles were selected based on relevance of abstract, article type and impact of the journal.

Results: Diagnostic criteria include Lovibond's profile sign, distal/interphalangeal depth ratio and Schamroth's sign. Three pathophysiological causes of clubbing can be distinguished: hypoxia, chronic inflammation and aberrant vascularization. A prominent role for vascular endothelial growth factor is suggested. Associated symptoms and clinical signs should guide the initial diagnostic evaluation. Finally, clubbing is a negative prognostic factor in certain pulmonary disorders, including cystic fibrosis.

Keywords: Algorithm; Digital clubbing; Lung cancer; Osteoarthropathy; Secondary hypertrophic; Vascular endothelial growth factor.

Publication types

  • Review

MeSH terms

  • Humans
  • Osteoarthropathy, Primary Hypertrophic* / diagnosis
  • Osteoarthropathy, Primary Hypertrophic* / pathology
  • Osteoarthropathy, Primary Hypertrophic* / physiopathology
  • Osteoarthropathy, Secondary Hypertrophic* / diagnosis
  • Osteoarthropathy, Secondary Hypertrophic* / pathology
  • Osteoarthropathy, Secondary Hypertrophic* / physiopathology
  • Prognosis