What Is Clubbing and What Does It Mean If I Have It? (2023)

Nail clubbing describes fingernails or toenails that are curved downward (like a spoon). The nails may feel soft when pressed and no longer sit even with the cuticle. This often occurs along with swelling or bulging of the tips of the fingers or toes as well.

Clubbed nails are not always cause for alarm, especially if nail clubbing runs in your family. Sometimes, though, nail clubbing is a warning sign of a serious condition such as a lung or heart condition or certain cancers.

This article explains the symptoms and causes of nail clubbing. It also details how healthcare providers use tests to make a diagnosis.

What Is Clubbing and What Does It Mean If I Have It? (1)

Nail Clubbing Stages and Symptoms

Physical changes in the fingernails are the surest sign of nail clubbing. Clubbing can also occur on the toenails. Clubbed nails become red, sponge-like, and swollen, almost like tiny balloons. This growth appears to occur from side to side as well as lengthwise.

Most often, clubbing occurs gradually. But the changes can occur rapidly, too, over a period of weeks. Either way, there are usually stages of progression.

  • In the first stage, the nail bed softens. This isn't usually something you can see.
  • In the second stage, the angle between the tissue above the visible top of your nail and the nail itself begins to change.
  • In the third stage, the clubbing becomes easier to see as the nail starts to adopt a convex shape.
  • In the late stages, the tip of the finger itself becomes thicker and wider. The nail and skin may take on a shiny appearance.

From close-up or a distance, clubbed nails resemble upside-down spoons. These changes may occur alone or with other symptoms, such as shortness of breath or coughing.

The medical term used to describe clubbing is hypertrophic osteoarthropathy.

What Causes Clubbed Nails?

Nail clubbing occurs from a buildup of tissue in the ends of the fingers (terminal phalanges). The nails become enlarged and curve downward. Why this happens is still largely a mystery to researchers.

It's thought that dilated blood vessels cause the fingers to swell, leading to the appearance of clubbing.

What is known is that the causes of clubbing fall into three categories:

Idiopathic: This is a category in which clubbing occurs for no obvious reason. It is unrelated to a medical issue; it just happens.

Inherited trait: There are a few ways that clubbing can be inherited. Most often the trait is inherited in an autosomal dominant fashion, meaning that if one of your parents carries the trait, there is a 50-50 chance that you will, too.

Secondary clubbing:This refers to clubbing that occurs as a result of a medical condition. Most often, secondary clubbing is related to a condition of the heart or lungs, such as:

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  • Lung cancer: This cancer accounts for about 90% of all clubbing cases, with nearly 30% of lung cancer patients experiencing clubbing. The deformity is more common among people with non-small cell lung cancer than small cell lung cancer.
  • Interstitial lung disease: A condition characterized by inflammation and scarring of the tissue around the alveoli, which are tiny air sacs in the lungs.
  • Other lung conditions: Some lung conditions linked to clubbing include bronchiectasis, idiopathic pulmonary fibrosis, empyema, pulmonary tuberculosis, and cystic fibrosis.
  • Congenital heart disease: Heart disease that is present from birth, especially cyanotic heart disease (a defect), often leads to clubbing.
  • Infectious endocarditis: This infection in the lining of the heart chambers and valves can be caused by bacteria or some other infectious organism.

Sometimes nail clubbing can have causes that are unrelated to the heart or lungs, such as:

  • Endocrine problems: Hyperthyroidism, especially Graves' disease, may be accompanied by clubbing.
  • Gastrointestinal conditions: People with celiac disease (a chronic disorder of the digestive tract), cirrhosis, Crohn's disease, and ulcerative colitis may develop clubbing.
  • Other cancers: Hodgkin's lymphoma often triggers clubbing.

How Lung Cancer Is Diagnosed

When to See a Healthcare Provider

If you notice signs of nail clubbing, make an appointment to see your healthcare provider. Because clubbed nails can be a sign of a serious condition, it is important to have them evaluated right away.

Diagnosis

Clubbing is often easy to diagnose based on a visual exam alone. But a healthcare provider may do other measurements to confirm the diagnosis:

  • Distal/interphalangeal depth ratio, which basically measures a finger's depth between the skin and nail bed
  • Lovibond angle, which focuses on the angle between the base of the nail and the nail
  • Schamroth sign, which is the lack of a "window" (gap) between the fingers when the digits from each hand are placed together and the tops of both hands are touching

A healthcare provider with experience in nail clubbing can be an invaluable resource.

Tests

If your healthcare provider decides you have clubbing, their first move will be to ask about your family history. They'll be interested to know if it's a hereditary trait.

The provider will then do a careful history and physical exam, keeping in mind the possible causes associated with secondary clubbing. Depending on your symptoms, the tests may include:

  • A chest X-ray and possibly a CT scan to look for lung cancer as well as other lung and heart-related conditions
  • An electrocardiogram (EKG) and/or echocardiogram to evaluate your heart
  • Arterial blood gases and/or pulmonary function tests to evaluate your lung function and look for underlying lung diseases
  • Blood tests, such as liver function tests and thyroid function tests

The next move, if any, will depend on what your healthcare provider discovers.

Chronic kidney disease and other disorders such as systemic sclerosis may cause finger changes that mimic the appearance of digital clubbing. Additional tests may be needed to rule these out.

How Chest X-Rays Can Sometimes Misdiagnose Lung Cancer

Nail Clubbing Treatment

There is no specific treatment plan for clubbing itself. The key is to find the underlying cause of the clubbing and treat that.

When the underlying cause has been successfully treated, the clubbing should go away on its own.

This may involve management by a specialist, depending on the cause. These could include pulmonologists, oncologists, infectious disease specialists, cardiologists, gastroenterologists, endocrinologists, and/or radiologists.

Summary

Nail clubbing causes the fingers (or toes) to swell and turn red while the nails turn downward. It could be just an inherited family trait or it could be a sign of a serious medical condition involving the heart, liver, lungs, intestine, or stomach. In fact, 90% of all clubbing cases are caused by lung cancer.

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Pinpointing the cause of clubbing is important. Once the cause is treated, the clubbing should go away on its own.

Frequently Asked Questions

5 Sources

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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.

  1. American Academy of Dermatology Association. 12 nail changes a dermatologist should examine.

  2. Sarkar M, Mahesh DM, Madabhavi I. Digital clubbing. Lung India. 2012;29(4):354-62. doi:10.4103/0970-2113.102824

  3. BMJ Best Practice. Evaluation of clubbing.

  4. Burcovschii S, Aboeed A. Nail clubbing. StatPearls.

  5. Jamieson A. The causes of finger clubbing: a list worth learning. Am J Med. 2011;124(7):e1-3. doi:10.1016/j.amjmed.2011.01.020

Additional Reading

What Is Clubbing and What Does It Mean If I Have It? (2)

By Lynne Eldridge, MD
Lynne Eldrige, MD, is a lung cancer physician, patient advocate, and award-winning author of "Avoiding Cancer One Day at a Time."

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FAQs

What clubbing means? ›

Clubbing often indicates problems with your lungs, heart or digestive system. Clubbing usually happens because of long-lasting (chronic) low levels of oxygen in your blood, known as hypoxemia.

What is the reason for clubbing? ›

Lung disease

Conditions that reduce lung function can reduce circulating oxygen levels and trigger clubbing. Lung diseases, especially cancer, are the most common cause of clubbing. Signs of lung disease include: chronic cough (present 8 weeks or longer)

Can clubbing be normal? ›

It could be just an inherited family trait or it could be a sign of a serious medical condition involving the heart, liver, lungs, intestine, or stomach. In fact, 90% of all clubbing cases are caused by lung cancer. Pinpointing the cause of clubbing is important.

Can clubbing be benign? ›

[2] Isolated nail clubbing can be a benign hereditary condition but given the multiple associated conditions underlying etiology should be ruled out.

What is it like to go clubbing? ›

So don't get too nervous, it's just a fun place like any other — but don't expect too much either. Clubs really are just loud places that are crowded and hot. Most of the time, the music would suck too. So aside from imagining that you're actually going to have fun there, you should also lower your expectations.

What is clubbing social? ›

Clubbing (also known as club culture, related to raving) is the activity of visiting and gathering socially at nightclubs (discotheques, discos or just clubs) and festivals. That includes socializing, listening to music, dancing, drinking alcohol and sometimes using recreational drugs.

How is clubbing diagnosed? ›

The Schamroth window test can be used to identify or confirm clubbing. If 2 opposing fingers are held back to back against each other, a diamond-shaped space should normally appear between the nail beds and the nails of the 2 fingers. In clubbing, this space (or window) is missing.

Is clubbing reversible? ›

Clubbing is usually acquired and is associated with certain cardiopulmonary and gastrointestinal disorders, but may occur in congenital or familial forms. Acropachy is an alternative term for clubbing. Acquired clubbing is often reversible when the associated condition is treated successfully.

How long does clubbing take to develop? ›

Finger clubbing generally takes years to develop. But it can happen quicker in certain conditions such as a lung abscess.

Does clubbing go away? ›

If the underlying cause of clubbed fingers is treated, yes, they can go away. 8 Heart and lung diseases are the most common problems. These may need to be treated with medication or surgery. What are the stages of finger clubbing?

Can smoking cause clubbing? ›

Can Smoking Cause Finger Clubbing? Nail clubbing is one of the common signs in regular smokers. Nail clubbing due to smoking occurs due to stimulation of the platelet-derived factor known as the vascular endothelial growth factor (VEGF).

How common are clubbed fingers? ›

The incidence of clubbing is unknown; it was present in about 1% of people admitted to an internal medicine unit of a hospital. Clubbing has been recognized as a sign of disease since the time of Hippocrates.

What disease causes clubbed fingers? ›

Clubbed fingers is a symptom of disease, often of the heart or lungs which cause chronically low blood levels of oxygen. Diseases which cause malabsorption, such as cystic fibrosis or celiac disease can also cause clubbing. Clubbing may result from chronic low blood-oxygen levels.

Is clubbing seen in COPD? ›

Chronic obstructive pulmonary disease (COPD) per se does not cause clubbing, but if clubbing is present in COPD, underlying lung cancer and bronchiectasis must be ruled out.

Can only 1 finger be clubbed? ›

Single-digit clubbing is a rare condition, usually caused by an expansive process in the distal phalanx. Enchondromas, osteoid osteoma, myxoid cyst, and myxochondromas have been described as the cause of this condition.

Do people go clubbing alone? ›

No, it's not weird to go to a nightclub alone – it's actually surprisingly liberating.

What do people do in a nightclub? ›

A nightclub (music club, discothèque, disco club, or simply club) is an entertainment venue during nighttime comprising a dance floor, lightshow, and a stage for live music or a disc jockey (DJ) who plays recorded music.

How do you hook up at a club? ›

Get a drink or some snacks and set up at a table in the middle of the club at a table. Pick a group activity like dancing, line-dancing or game playing to get everyone to mingling. Talk to strangers. Ask them to join in on a game or activity and watch for those with similar interests.

How old do you have to be to go clubbing? ›

As per Council/Government law, all nightclubs guests have to be 18+. Some clubs require cleints to be over 21.

How do social clubs work? ›

The goal of a social club is to gather members for regular or semi-regular social activities. This entails very little overhead and members can largely self-organize with a loose and minimal structure. Our baking club would most likely be an example of this kind of club.

When did people start clubbing? ›

1940s Knees Up

Its ancestors lie in the ballrooms and dancehalls of the late 19th and early 20th centuries, which blossomed into the jazz clubs, record hops, disc sessions and discothèques in the 1940s and 1950s youth culture explosion.

Is finger clubbing serious? ›

Clubbed fingers by themselves are not harmful, but since it can be a sign of lung cancer, among other diseases, it is important that your medical team identifies the cause and that you are treated for your underlying condition.

What do clubbed nails mean? ›

Nail clubbing occurs when the tips of the fingers enlarge and the nails curve around the fingertips, usually over the course of years. Nail clubbing is sometimes the result of low oxygen in the blood and could be a sign of various types of lung disease.

Do people go clubbing alone? ›

No, it's not weird to go to a nightclub alone – it's actually surprisingly liberating.

Can smoking cause clubbing? ›

Can Smoking Cause Finger Clubbing? Nail clubbing is one of the common signs in regular smokers. Nail clubbing due to smoking occurs due to stimulation of the platelet-derived factor known as the vascular endothelial growth factor (VEGF).

Is clubbing reversible? ›

Clubbing is usually acquired and is associated with certain cardiopulmonary and gastrointestinal disorders, but may occur in congenital or familial forms. Acropachy is an alternative term for clubbing. Acquired clubbing is often reversible when the associated condition is treated successfully.

What do nails look like with heart problems? ›

Nail clubbing is when a nail curves under at the tip of the finger. It could indicate heart disease, inflammatory bowel disease, lung disease, liver disease, thyroid disease, or HIV/AIDS. Puffy redness near the cuticle can indicate inflammation, a bacteria or yeast infection, Lupus, or other connective tissue disease.

How do you check clubbing? ›

The Schamroth window test can be used to identify or confirm clubbing. If 2 opposing fingers are held back to back against each other, a diamond-shaped space should normally appear between the nail beds and the nails of the 2 fingers. In clubbing, this space (or window) is missing.

Can Rheumatoid arthritis cause clubbing of fingers? ›

Clubbing. There is a chance your nails may experience clubbing from RA if your lungs are affected. Clubbing occurs when your nails begin to curve downward as they grow. This creates swelling in your fingers.

Can you feel a tumor in your lung? ›

Chest pain: When a lung tumor causes tightness in the chest or presses on nerves, you may feel pain in your chest, especially when breathing deeply, coughing or laughing.

Does COPD cause finger clubbing? ›

Chronic obstructive pulmonary disease (COPD) per se does not cause clubbing, but if clubbing is present in COPD, underlying lung cancer and bronchiectasis must be ruled out.

Is it OK to go out by yourself? ›

Benefits of going out alone

Being solo can also gently push you to be more sociable, because if you want to talk to someone you'll need to make it happen yourself. You can go to events on your own terms. No having to stay longer than you'd like because your friends aren't tired yet.

What do you wear to a nightclub? ›

Business Casual wear is comfortable and will get you into most clubs. Cocktail Attire can be coupled with comfortable shoes. They don't always have to be high heels. Be “Sexy But Classy.” You don't need to expose a lot to look amazing.

How do I go out on my own? ›

With that in mind, here are six ways to go out by yourself and still have a blast:
  1. Use It As An Excuse To Get Dressed Up (Not That You Need One) ...
  2. Do Something You Love. ...
  3. Actually Talk To People. ...
  4. Get Off Your Phone. ...
  5. Don't Be Afraid To Smile If You Want To. ...
  6. Be Safe.
6 Nov 2015

What do smokers nails look like? ›

"Yellow-stained nails are one of the biggest tell-tale signs that you're a smoker or that you used to smoke. This is because the nicotine and tar found in cigarettes stains both the nail and surrounding nail bed – but that's not all. Smoking blocks oxygen to the fingernails which can also result in a yellow hue.

How do you fix clubbing fingers? ›

No specific treatment for clubbing is available. Treatment of the underlying pathological condition may decrease the clubbing or, potentially, reverse it if performed early enough. Once substantial chronic tissue changes, including increased collagen deposition, have occurred, reversal is unlikely.

Why are my nails blue? ›

Blue fingernails, or cyanosis, occur when your blood doesn't have enough oxygen. It is most often caused by cold temperatures. Occasionally, it can be caused by medical conditions. These include diseases of the lungs or heart, or atypical blood cells or vessels.

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