Clubbed Digits: An Enigma

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Abstract
I. Introduction Clubbing is a frequently observed, often misdiagnosed, and inadequately explained phenomenon recognized since antiquity. Hippocrates 1,2 first described it in empyema, noting that the "nails of the hands are bent, the fingers are hot especially their extremities." 3 Aretaeus associated clubbing with internal disease, and Aurelianus emphasized the increase in volume of the fingertips.4 Pigeaux 5 published in 1832 the first definite work on the subject, and Marie wrote his classic article in 1890.6 Known by many different names, clubbing is most commonly referred to as pulmonary hypertrophic osteoarthropathy. II. Definition Clubbing is a clinical sign observed in the terminal phalanges which may or may not be associated with a pathological condition. If seen during disease, clubbing constitutes the early stage of a process of unknown pathogenesis and etiology in which the underlying condition causes changes in the soft tissues, in the periosteum, in the bone

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