Fingernail Clubbing: A Sign of Lung Cancer?

Nail clubbing may occur with many conditions. In these two patients, it heralded lung cancer.

Nail clubbing may occur with many conditions. When combined with nicotine staining, as shown in Figure A, it is a particularly worrisome finding. This image from Figure1 shows clubbing and nicotine stains on the hands of a patient with lung cancer.

The patient in Figure B presented with chronic shoulder pain: the nail clubbing was of recent onset. In this case, it heralded the presence of lung cancer.

Lung tumors, especially Pancoast tumors, not infrequently mimic musculoskeletal conditions of the shoulder. Consider adding a chest film to the workup of shoulder pain in the proper clinical setting or when there are no positive findings on examination of the shoulder.