HPOA

Hypertrophic pulmonary osteo-arthropathy (Pierre Marie-Bamberger syndrome)
This is the combination of clubbing and thickening of periosteum (connective tissue lining of the bones) and synovium (lining of joints), and is often initially diagnosed as arthritis. It is commonly associated with lung cancer.

Primary HOA
Primary hypertrophic osteo-arthropathy is HPOA without signs of pulmonary disease.It is also known as the Touraine-Solente-Golé syndrome. This condition has been linked to mutations in the gene on the chromosome4 coding for the enzyme 15-hydroxyprostaglandin dehydrogenase (HPGD); this leads to decreased breakdown of prostaglandin E2.

clubbing( continued)

Clubbing is associated with:
• Lung disease:
o Lung cancer,
o Interstitial lung disease
o Tuberculosis
o Suppurative lung disease: lung abscess, empyema, bronchiectasis, cystic fibrosis
o Mesothelioma
• Heart disease:
o Congenital cyanotic heart disease (most common cardiac cause),eisenmengers synd
o Subacute bacterial endocarditis
o Atrial myxoma (benign tumor)
• Gastrointestinal and hepatobiliary:
o Malabsorption
o Crohn's disease and ulcerative colitis
o Cirrhosis, especially in primary biliary cirrhosis[5]
o Hepatopulmonary syndrome, a complication of cirrhosis[6]
• Others:
o Hyperthyroidism (thyroid acropachy)[7]
o Familial and racial clubbing and "pseudoclubbing" (people of African descent often have what appears to be clubbing)
o Vascular anomalies of the affected arm such as an axillary artery aneurysm (in unilateral clubbing

clubbing

clubbing..or lovibonds sign..or hippocratic fingers( he ws the first to describe clubbing as a sign of illness)

increase in lovibond angle( onychodermal agle) > 160 degrees

how to check?

1.look tangetially with fingers at ur eye level

2.eliciting fluctuation in the nail bed

3.schamroths sign

4.digital index ( circumference at nail bed / circumference at the distal interphalangeal jt...and then take avg of all the fingers..if its > 1 then clubbing)

Drum stick appearance- congenital cyanotic heart diseases and bronchiectasis

Parrot beak appearance- bronchogenic carcinoma

INDEX FINGER is usually affected first

acute clubbing ( within 10-14 days) -lungabscess and empyema thoracis

(clubbing is also reversible in these 2 conditions)

PSUEDO clubbing- due to resorption of sub periosteal resorption of terminal phalanges seen in

leprosy

scleroderma

hyperparathyroidism

acromegaly

PAINFULL clubbing-CA lung, SABE and lung abscess