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    Clubbing is elevation of the nail and widening of the distal phalanx caused by swelling of the subungual capillary bed resulting from increased collagen deposition, interstitial inflammation with edema, and proliferation of the capillaries themselves.

    Increased vascular supply to the nail bed and increased connective tissue growth, together producing the characteristic clubbing.

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    The disease is classified either as primary (hereditary or idiopathic) or secondary.

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    This clinical triad of digital clubbing, arthralgias, and ossifying periostitis has been recognized since the late 1800s and was previously known as hypertrophic pulmonary osteoarthropathy (HPOA).

    It is a syndrome characterized by excessive proliferation of skin and bone at the distal parts of extremities and by digital clubbing and periostosis of the tubular bones.

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