Drumstick Finger: Causes and Diagnosis

Brief overview

  • What are drumstick fingers? Piston-like thickening at the ends of the fingers, often combined with watch glass nails (nails that bulge excessively in the longitudinal direction)
  • Causes: usually lung or heart disease (lung cancer, pulmonary fibrosis, chronic heart failure, etc.), sometimes also other diseases such as liver or gastrointestinal tract diseases (hepatitis, chronic inflammatory bowel disease, etc.)
  • What to do with drumstick fingers? Always see a doctor, as there is often an underlying serious illness
  • Treatment: Therapy of the underlying disease, which usually also causes the drumstick fingers to recede

Drum flail fingers: Description

Drum flail fingers are fingers whose end phalanges are distended like pistons and have a thickening of the soft tissue. In addition, the fingernails are often excessively curved in the longitudinal direction (“watch glass nails”).

Drum flail fingers can occur on one or both sides and can be congenital or acquired. They are a sign of a chronic lack of oxygen (hypoxia) in peripheral regions of the body, i.e. those remote from the trunk. This is often caused by lung or heart disease. However, there are also other possible causes of drumstick fingers.

Drumstick fingers: causes and possible diseases

Double-sided drumstick fingers: Causes

Double-sided drumstick fingers are often caused by lung or heart disease or diseases of the digestive tract. However, other causes are also possible.

Lung diseases

Double-sided drumstick fingers with watch glass nails are often due to a lung disease such as:

  • Lung cancer (bronchial carcinoma): most common cause of double-sided drumstick fingers with watch glass nails
  • Bronchiectasis (sac-shaped enlargement of the bronchial tubes that cannot regress)
  • Emphysema (over-inflation of the small air sacs in the lungs)
  • Pulmonary tuberculosis (bacterial infection of the lungs)
  • Pulmonary fibrosis (proliferation of connective tissue fibers in the lungs)
  • Cystic fibrosis (congenital metabolic disorder in which a lot of viscous mucus is produced, especially in the airways)

Heart disease

In some cases, drumstick fingers can be attributed to chronic heart failure (cardiac insufficiency) or certain heart defects (e.g. the congenital heart disease tetralogy of Fallot). Heart tumors and inflammation of the inner lining of the heart (endocarditis) are also possible causes.

Liver diseases

Gastrointestinal diseases

Various diseases of the digestive tract can also be the trigger for drumstick fingers, for example:

  • chronic inflammatory bowel disease (Crohn’s disease, ulcerative colitis)
  • Intestinal tuberculosis (tuberculosis that manifests itself in the digestive tract)
  • Polyposis of the colon (numerous polyps in the large intestine)
  • chronic amoebic dysentery
  • colon cancer
  • Lymph gland cancer in the abdomen (abdominal Hodgkin’s disease)

Other causes

Sometimes double-sided drumstick fingers occur after surgical removal of the entire thyroid gland (thyroidectomy). Other possible causes include tumors in the throat area and chronic bone inflammation (osteomyelitis) with amyloidosis. This is the deposition of altered proteins between the body cells.

Unilateral drumstick fingers: causes

Possible causes of unilateral drumstick fingers are, for example

  • Aneurysm (sac-shaped expansion of the artery wall), for example in the area of the aortic arch (section of the main artery close to the heart) or in the subclavian artery (subclavian artery)
  • Lymphangitis (inflammation of the lymphatic vessels)
  • Pancoast tumor (special form of lung cancer)

Drum flail finger: what to do?


The doctor will first take your medical history (anamnesis) in a detailed consultation with you. For example, he will ask you about all your symptoms, any previous illnesses (such as recurring pneumonia) and your nicotine consumption.

During the subsequent physical examination, the doctor will examine the drumstick fingers and (if present) the watch glass nails. He listens to your chest and listens for heart sounds and rales in your lungs. The doctor also looks for signs of anemia, such as pale sclerae (the white part of the eye) and mucous membranes.

Laboratory tests are also important to determine the cause of drumstick fingers. Using a blood gas analysis, the doctor can detect the lack of oxygen. He can also perform a differential blood count (determination of the different types of leukocytes) and measure other blood values such as creatinine, urea, blood salts (electrolytes), liver and thyroid values.

There are also other tests that can help to identify the cause of drumstick fingers. These include

  • X-ray of the chest (chest X-ray)
  • Ultrasound examination of the heart (echocardiography)
  • Pulmonary function test
  • Analysis of the sputum (sputum diagnostics)
  • Lung endoscopy (bronchoscopy)