Physical Exam: Pulmonary

Clubbing of Nails

Clubbing results from a build up of material under the proximal nail bed resulting in a loss of the normal oblique angle between the nail and the cuticle.

Inspection

1. The angle can be observed by placing the thumbs together nail to nail, knuckle to knuckle. If the angle is normal, there is a diamond space between the thumbs.
2. Normally, the diameter of the digit at the cuticle should be less than at the knuckle.

Palpation

1. In clubbing, the nail bed develops a sponginess that may be appreciated prior to the loss of angle.

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