Clubbing history and symptoms

Symptoms of the development of clubbing occur in five steps. They are as follows:^[1]

1. Fluctuation and softening of the nail bed (increased ballotability)
2. Loss of the normal <165° angle (“Lovibond angle“) between the nailbed and the fold (cuticula)
3. Increased convexity of the nail fold
4. Thickening of the whole distal (end part of the) finger (resembling a drumstick)
5. Shiny aspect and striation of the nail and skin

Medical history questions may include:

• Do you have any breathing difficulty?
• Does clubbing affect the fingers, toes, or both?
• Is it becoming more noticeable?
• Is the skin ever bluish-colored?
• What other symptoms do you have?
• When did you first notice this?

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