Isolated single-digit clubbing as a clinical sign of benign distal phalanx tumors.

INTRODUCTION

Isolated single-digit clubbing is an uncommon clinical finding that has been reported mainly in isolated case reports describing benign tumors of the distal phalanx, with limited characterization in the hand surgery literature.

METHODS

A retrospective chart review was performed of patients presenting with single-digit clubbing to a tertiary referral center between 2006 and 2023. Patients with diffuse or bilateral clubbing, prior local trauma or infection, or systemic disease associated with clubbing were excluded. Medical records were reviewed for demographic information, clinical presentation, physical examination findings, imaging studies, histopathologic diagnosis, and postoperative outcomes.

RESULTS

Six patients (4 women, 2 men; median age, 32 years) presented with progressive isolated clubbing and nail deformity involving a single digit, most commonly the middle finger (n = 4) and less commonly the index finger (n = 2). The median time from symptom onset to referral was 2 years (range, 1-10 years; mean, 3.2 years). All patients underwent clinical and radiographic evaluation and subsequently surgical excision, with histopathology demonstrating osteoid osteoma in five patients and enchondroma in one. Following operative treatment, all osteoid osteoma patients showed complete resolution of clubbing, whereas the enchondroma patient showed significant but incomplete improvement, with persistent residual clubbing. No complications, revision procedures, or recurrences were documented during a median postoperative follow-up of 7 years (range, 3-17 years).

CONCLUSION

Isolated single-digit clubbing is an uncommon but recognizable clinical finding that may be associated with benign distal phalanx tumors. In patients presenting with chronic pain and nail deformity in the absence of systemic illness or trauma, this physical sign should prompt evaluation for localized distal phalanx pathology.

LEVEL OF EVIDENCE: Therapeutic Level V.