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A. Characteristicsnavigator

  1. Abnormal proliferation of skin and osseous structures at distal extremities
  2. Clubbing is very prominant [2]
  3. Periostosis of the tubular bones with synovial effusions
  4. Likely due to abnormal activation of endothelium by platelets
  5. Primary and secondary disease

B. Classification of Secondary HPOAnavigator

  1. Cardiac
    1. Congenital cyanotic disease
    2. Infective endocarditis
  2. Pulmonary Disease
    1. Cystic Fibrosis
    2. Pulmonary Fibrosis
    3. Cancer: primary or metastatic
    4. Chronic Infections
    5. Mesothelioma
    6. Arteriovenous Fistula
  3. Hepatic
    1. Cirrhosis
    2. Carcinoma
  4. Intestinal
    1. Inflammatory bowel disease
    2. Chronic infections
    3. Laxative abuse
    4. Gastrointestinal polyposis
    5. Malignant tumors
  5. Mediastinal
    1. Esophageal Ca
    2. Thymoma
    3. Achalasia
  6. Miscellaneous
    1. Graves' Disease
    2. Thalassemia
    3. Other malignancy
    4. Infective arteritis
    5. Hemiplegia
    6. Antiphospholipid antibodies may be present
  7. POEMS Syndrome has been added recently

C. Management navigator

  1. Detection of clubbing: profile angle and phalangeal depth ratio for quantitation [2]
  2. Usually asymptomatic
  3. Main problem is appearance
  4. Correction of underlying disorder may sometimes (partially) reverse HTOA
  5. Nonsteroidal antiinflammatory drugs (NSAIDS) may be effective in painful cases

References navigator

  1. Martinez-Lavin M. 1997. Curr Opin Rheumatol. 9(1):83 abstract
  2. Myers KA and Farquhar DRE. 2001. JAMA. 286(3):341 abstract