Diagnosis of Clubfoot
Clubfoot Diagnosis: Book Excerpts
Diagnosis of Clubfoot: medical news summaries:
The following medical news items
are relevant to diagnosis and misdiagnosis issues for Clubfoot:
Diagnostic Tests for Clubfoot: Online Medical Books
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CLUBBING OF THE FINGERS:
Ask the following questions:
(Algorithmic Diagnosis of Symptoms and Signs)
- Is there cyanosis? Cyanosis should make one think of cyanotic congenital heart disease and pulmonary arteriovenous aneurysms.
- Is there a cough or dyspnea? A cough or shortness of breath should make one think of a pulmonary condition such as bronchiectasis, chronic interstitial fibrosis, asbestosis, emphysema, or carcinoma of the lung. Lung abscesses and tuberculosis must also be considered, although they are less frequent.
- Is there a fever? A fever along with the clubbing should make one think of empyema, lung abscess, tuberculosis, or subacute bacterial endocarditis.
DIAGNOSTIC WORKUP
An EKG and chest x-ray will identify the most common causes of clubbing. A CBC, sedimentation rate, and chemistry panel should also be done routinely. If there is fever, a sputum smear, culture and sensitivity, and blood culture should be done. An upper GI series, an esophagogram, and a barium enema will identify most GI disorders. Cyanotic congenital heart disease will require further workup, including a cardiology consultation, cardiac catheterization, and angiocardiography. A thoracentesis may be necessary to diagnose empyema. Sputum cytology is the first step if a neoplasm is suspected. Bronchoscopy may be necessary to diagnose carcinoma of the lung. A CT scan of the chest can be used to diagnose bronchiectasis.
If a more extensive workup is necessary, a referral to a pulmonologist or cardiologist should be considered.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Clubbing:
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
-
Pulmonary
–Cystic fibrosis
–Bronchiectasis
–Empyema
–Pulmonary abscess
–Tuberculosis, aspergillosis
–Asthma complicated by infections
–Pulmonary alveolar proteinosis
–Sarcoidosis
–Interstitial pneumonitis (lymphoid, chronic)
–Pulmonary fibrosis
-
Cardiovascular
–Cyanotic congenital heart disease
–Congestive heart failure
–Myxoid tumor
–Subacute bacterial endocarditis
–Myxomas
-
Gastrointestinal
–Inflammatory bowel disease
–Gardner syndrome
–Parasitosis
–Biliary cirrhosis or biliary atresia
–Chronic active hepatitis
–Celiac disease
-
Other
–Diamond syndrome (myxedema, exophthalmos, clubbing)
–Thyrotoxicosis
–Hypervitaminosis A
–Malnutrition
-
Acquired, one or more digits
–Aortic/subclavian aneurysm
–Brachial plexus injury
–Shoulder subluxation
–Trauma
–Maffucci syndrome
–Gout
–Sarcoidosis
–Severe herpetic whitlow
-
Idiopathic
-
Hereditary, familial (isolated)
–Pachydermoperiostosis
-
Pseudoclubbing (broad distal phalanges with
normally shaped nails)
–Apert syndrome
–Pfeiffer syndrome
–Rubinstein-Taybi syndrome
Workup and Diagnosis
- Physical exam is diagnostic
–Often begins in the thumb and index fingers; earliest signs are softening and loss of angle at the base of the nail; nail beds are excessively compressible and skin overlying the base of the nail is red and shiny
–The ungual-phalangeal angle (Lovibond angle): Measured by visualizing a “V,” with the tip placed on the nail fold, one arm pointing toward the tip of the nail and the other arm oriented along the finger; with clubbing the angle is ≥180°
–Opposition of the dorsum of two fingers from opposite hands in normal individuals delineates a diamond-shaped window at the base of the nail beds; in early clubbing, this window is obliterated
–The clubbing index (CI) is a ratio of distal phalangeal depth to interphalangeal depth; CI is equal or greater to 1.0 when clubbing is present; in cystic fibrosis patients, CI correlates negatively with PaO2, FEV1, FEF25-75%, and positively with the residual volume
25–75%
–Painful clubbing is indicative of periostitis associated with hypertrophic pulmonary osteoarthropathy
–Toe clubbing can be seen in patent ductus arteriosus, reversed shunt, and pulmonary hypertension
- Histologic changes of the nail matrix include increased dermal fibroblasts, mucoid degeneration; and interstitial edema, infiltration with plasma cells, lymphocytes, and primitive fibroblasts
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
CLUBBING AND PULMONARY OSTEOARTHROPATHY:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
The clinical approach to clubbing involves being certain that clubbing is present. A curved fingernail is not good evidence, and the “drumstick” appearance (which makes the finger look like a true club) does not occur until late. Early clubbing is determined by the angle between the nail-covered portion of the dorsal surface of the terminal phalanx and the skin-covered portion. Normally this angle is 160 degrees. When the angle becomes 180 degrees and disappears, that is, when the terminal phalanx becomes flat, clubbing exists.
Careful examination for cyanosis and a thorough evaluation of the heart and lungs will determine the cause in most cases. Pulmonary function studies, and arterial blood gases before and after exercise and before and after 100% oxygen, will help confirm the diagnosis in many cases. Of course, lung scans and angiocardiography are frequently necessary. Blood cultures, stool culture and examination, and thorough radiologic studies of the GI tract will be necessary in obscure cases.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
Clubbing:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
You'll probably detect clubbing while evaluating other signs of known pulmonary or cardiovascular disease. Therefore, review the patient's current plan of treatment because clubbing may resolve with correction of the underlying disorder. Also, evaluate the extent of clubbing in the fingers and toes. (See Checking for clubbed fingers.)
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Clubfoot:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
Early diagnosis of clubfoot is usually possible because the deformity is obvious. In subtle deformity, however, true clubfoot must be distinguished from apparent clubfoot (metatarsus varus or pigeon toe). Apparent clubfoot results when a fetus maintains a position in utero that gives his feet a clubfoot appearance at birth. This can usually be corrected manually. Another form of apparent clubfoot is inversion of the feet, resulting from the peroneal type of progressive muscular atrophy and progressive muscular dystrophy. In true clubfoot, X-rays show superimposition of the talus and the calcaneus and a ladderlike appearance of the metatarsals. (See Recognizing clubfoot.)
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Clubbing:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
You’ll probably detect clubbing while evaluating other signs of known pulmonary or cardiovascular disease. Therefore, review the patient’s current plan of treatment because clubbing may resolve with correction of the underlying disorder. Also, evaluate the extent of clubbing in both the fingers and toes. (See Checking for clubbed fingers, page 182. )
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Nail Phenomena/Clubbing:
Differential Overview
(Field Guide to Bedside Diagnosis)
Phenomena
❑ Pitting
❑ Transverse depression
❑ Transverse white line
❑ Nailfold telangiectasias
❑ Nailfold infarcts
❑ Splinter hemorrhages
❑ Onycholysis
❑ Spoon nails
❑ Blue-green nails
❑ White nails
❑ Half-and-half nails
❑ Yellow nails
❑ Blue lunulae
❑ Red lunulae
❑ Black longitudinal streak
Clubbing
❑ Bronchogenic cancer
❑ Tuberculosis
❑ Endocarditis
❑ Inflammatory bowel disease
❑ Familial
❑ Trauma
❑ Grave disease
❑ Cirrhosis
❑ Cystic fibrosis
❑ Cyanotic congenital heart disease
❑ Pulmonary fibrosis
❑ Mediastinal Hodgkin disease
❑ Mesothelioma
❑ Lung abscess
❑ Bronchiectasis
❑ Hypertrophic osteoarthropathy
❑ Pachydermoperiostosis
Diagnostic Approach
Nails contain an archive of information about physiologic conditions affecting their growth, similar to the way tree rings record the weather of summers past. If examined closely, they may also contain the subtlest of clues to important
systemic illness, such as endocarditis.
Clubbing is most sensitively detected by loss of the normal nail angle when seen in profile, or by putting corresponding fingers back to back and looking for loss of the diamond of light. Springiness or ballotability of the base of the nail is another early sign. The overlying skin is smooth and shiny, and the nailbeds are cyanotic. Nails of patients with chronic paronychia may be confused with clubbing.
When clubbing is present, specifically examine for findings of associated illness including peripheral stigmata of endocarditis, murmurs, splenomegaly, jaundice, wheezes, rales, pleural effusion, supraclavicular adenopathy, hepatomegaly, abdominal mass, thyromegaly, and ophthalmopathy.
Unilateral clubbing may be caused by impairment of the vascular supply to the arm. Causes include aortic or subclavian artery aneurysm, anomalous aortic arch, pulmonary hypertension with patent ductus arteriosus, brachial arteriovenous fistula, superior sulcus lung tumor, and recurrent shoulder dislocation. Unidigital clubbing may be caused by median nerve injury or sarcoidosis. Clubbing of toes without fingers can be seen in coarctation of the aorta.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Clubfoot:
Diagnosis
(Handbook of Diseases)
An early diagnosis of clubfoot is usually no problem because the deformity is obvious. With subtle deformity, however, true clubfoot must be distinguished from apparent clubfoot (metatarsus varus or pigeon toe).
Apparent clubfoot results when a fetus maintains a position in utero that gives his feet a clubfoot appearance at birth. This can usually be corrected manually.
Another form of apparent clubfoot is inversion of the feet, resulting from the peroneal type of progressive muscular atrophy and progressive muscular dystrophy. With true clubfoot, X-rays show superimposition of the talus and the calcaneus and a ladderlike appearance of the metatarsals.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Clubbing:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
You'll probably detect clubbing while evaluating other signs of known pulmonary or cardiovascular disease. Therefore, review the patient's current plan of treatment because clubbing may resolve with correction of the underlying disorder. Also, evaluate the extent of clubbing in the fingers and toes. (See Checking for clubbed fingers.)
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
CLUBBING AND PULMONARY OSTEOARTHROPATHY:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
The clinical approach to clubbing involves being certain that clubbing
is present. A curved fingernail is not good evidence, and the “drumstick”
appearance (which makes the finger look like a true club) does not occur
until late. Early clubbing is determined by the angle between the
nail-covered portion and the skin-covered portion of the dorsal surface of
the terminal phalanx. Normally this angle is 160 degrees. When the angle
becomes 180 degrees and disappears, that is, when the terminal phalanx
becomes flat, clubbing exists.
Careful examination for cyanosis and a thorough evaluation of the heart and
lungs will determine the cause in most cases. Pulmonary function studies,
and arterial blood gases before and after exercise and before and after
100% oxygen, will help confirm the diagnosis in many cases. Of course,
lung scans and angiocardiography are frequently necessary. Blood cultures,
stool culture and examination, and thorough radiologic studies of the
gastrointestinal tract will be necessary in obscure cases.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
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