Hypertrophic pulmonary osteoarthropathy

Hypertrophic pulmonary osteoarthropathy is a rare disorder that is associated with severe clubbing.

This disorder is characterised by:

• subperiosteal new bone formation at the distal ends of long bones, metatarsals, metacarpals and proximal phalanges
• symmetrical arthropathy of adjacent joints
• clubbing of the fingers
• gynaecomastia

The patient may complain of dull aching and sometimes swelling of the wrist and ankles.

This syndrome is most commonly seen in patients with bronchogenic carcinoma - 90% of cases are associated with bronchogenic carcinoma, especially peripheral squamous cell tumours - but also:

• other intrathoracic tumours
• chronic lung sepsis
• chronic liver disease

The pain of the symmetrical arthropathy may be helped by vagotomy below the origin of the recurrent laryngeal nerve.