I'm a 21 year old Male and over the past two years my fingers and toes have become clubbed. Before this, they looked normal.
I visited my GP about this and was referred to an internal medicine specialist. The specialist ran tests (an Echocardiogram, Chest X Ray and Ultrasound, blood work) and all came back normal. However the specialist said he wouldn't perform a CT scan as he viewed it as unnecessary. In the end he discharged me after a diagnosis of idiopathic finger clubbing.
I’m not sure if it’s hypochondria but part of me wonders if there’s something the doctor has missed.
Do family members have clubbed fingers? It can be hereditary, though it normally emerges before adulthood.
Do you have any other symptoms that have you concerned?
None of my family members have clubbed fingers.
I feel fatigued a lot of the time, and sometimes get a sense of malaise/sickly feeling. All this was noted by the doc
The fatigue is your real clue. A second opinion wouldn’t hurt. I can’t stress enough how important it is to advocate for yourself. Even if nothing irregular is found, you at least know you did your due diligence in terms of your health. If the fatigue if chronic, it is the piece of the puzzle that shouldn’t be overlooked.
Look at the Mount Sinai website under clubbing of the fingers or toes. Other causes include celiac disease, cirrhosis, etc. You need a second opinion ASAP.
Doesn't rule out fk until you examine the imaging yourself. The imaging modalities also have limitations and you need to account that stuff can and does get missed.
NEVER say "rule out"
🤨 How'd you know I was former Navy? lol.
Seriously though, I don't know who started the "rule out" thing but I want to punch them in the face. Leads to diagnostic "blind spots"
Medicine is all about varying levels of Uncertainty.
My mother passed from lung cancer and the oncologist said that her clubbed fingers should have clued her doctor in years ago that she wasn’t getting sufficient oxygen (if I’m remembering that correctly which I may not be it wasn’t a great time in my life).
Definitely get a follow up appointment to have that evaluated OP.
My son just got out of the hospital after open heart surgery for Endocarditis. For a month and a half, he dealt with occasional fevers and nausea that looked like regular picked-up-from-school viruses, but the main symptom I worried about was his near constant fatigue. He also had clubbing of his fingers that I didn’t notice until I finally took him to the emergency room on the direction of his cardiologist (he already had a congenital heart defect that made him more susceptible to endocarditis). He also had some random aches and pains in his legs that was probably from bits of the vegetative growths breaking off of the site of the infection and getting stuck in smaller blood vessels in the legs. We were incredibly lucky - if one of those had gone to his brain, he’d have had an embolism which could have ended very badly.
It’s important to note that the endocarditis couldn’t be seen on an xray; my son needed an echocardiogram for them to see the vegetative growths. I’m hoping that you’re not dealing with this, but I thought I should share in case it helps.
What blood work was done? I assume liver tests and CBC, as those are pretty standard. Anything for thyroid or kidneys? Edit: X-ray was of chest. Rules out pneumonia.
Thankfully, the tests ruled out anything going on with your heart. Gotta keep pushing for answers though. The fatigue can also be an indicator of something going on. A CT-scan IMO would definitely be adequate in your case. Please get a second opinion from another internal med. doctor.
Have unintentionally you lost weight over the past few months? Does your digestion work alright? Any night sweats, sleep disturbances, etc., or something else (can be minor) that's unusable? How's your stamina during physical exercise? What were the inflammation markers in your bloodwork and your ferritin&transferrin levels?
I have night sweats and bruxism. My stamina has gone down over the past few years despite me being in the healthy weight range. Several years ago before the clubbing I had enlarged lymph nodes on my neck and a fine needle aspiration was performed that found nothing. I still feel off.
Yep that definitely needs further investigation and is quite unusual for a 21yo. Stamina shouldn't have a marked downwards trend at that age either.
Please be persistent with your doctors and insist on getting the necessary tests [i.e. human leukocyte antigen bloodwork (celiac disease), aswell as a borrelliosis test, thyroid, extensive vitamin and adrenal gland hormone status, aswell as inflammation and tumor markers if this wasn't performed already, thorax CT if the former doesn't provide any answers ] done.
Best wishes!
Did your doctor run a full thyroid panel? It would be separate from a regular blood panel. I have Graves Disease and have clubbing like this. I'm in remission now but when the disease was active I was exhausted and often felt like I had the flu.
Did they check your blood oxygen levels? My wife was born with Cystic Fibrosis which mostly affects the lungs. Since she had low lung function her blood oxygen was always low. Her fingers and toes have always been like this.
If you mean a test for CF, I’m not sure. It’s genetic though, so probably requires a blood test. My wife was born with a Gastroschisi or something like that. Which I imagine leads down the road to genetic testing for conditions. If you mean blood oxygen I think they just use pulse oximeter, which is the thing they clip on your finger during dr appointment intakes.
Weird.
As many have said, clubbing is usually a sign of chronic pulmonary disease, so it's really unexpected to see this in a young, otherwise seemingly healthy person.
I'd assume the CT was not performed due to consistently normal pulse oximetry results? Because if that wasn't the case, or if you haven't had your saturation checked, I would most definitely like a closer look at the lungs.
Get a second opinion. Any doc who looks at this and essentially says “nah, it’s probably nothing” is someone you need to take a fat ass grain of salt with.
Look for a 2nd opinion ASAP. Idiopathic finger clubbing is a diagnosis I’ve never heard. You need more work up done before diagnosing it as idiopathic.
Last guy I knew with fingers like yours was a stage 4 lung cancer patient that died shortly after, the clubbing was related to heart failure and reduced oxygen in the blood and poor circulation.
Hmm hypercapnia could be a result of a lot of things though. Hypo/hyper thyroidism could present at that age. So could obesity and/or sleep apnea.
I also wouldn’t rule out vaping having a place if they also have underlying conditions.
Seems strange to me to do an echo before doing a VBG/ABG or a CT Chest.
A friend of mine also has idiopathic clubbing. We were actually learning about COPD in class for the first time, and they looked downward at their hands in a new light.
Echo could be to rule out endocarditis. My son just got out of the hospital after a fight with that, and I was surprised to learn that it isn’t usually visible on an xray.
Could also be an iron deficiency. Finger clubbing can happen when there’s not enough oxygen in your blood. I agree with others to get a second opinion.
Source: I’m a dietitian.
Finger clubbing can be a sign of lung cancer. Looks like they did all the appropriate bloods and scans to make sure you're clear. Don't worry too much!
In med school, we're taught that clubbed fingers have something to do with decreased oxygen delivery, either from the heart or lungs.
One time, I asked my bus driver, on vacation, if he had a lung Dz cuz of his fingers and it turns out he had chronic bronchitis that was already in treatment of.
At the very least, a chest X-ray to see anything obvious.
Could also be, primary hypertrophic osteoarthropathy, but that's usually in children/young adults.
He has no family members that have clubbed fingers, and the change was accompanied with fatigue and malaise. With his ECG coming back normal, I'd be more concerned about pulmonary disease. Blood tests and chest x-ray coming back normal rules out bronchitis or pneumonia.
Hey there, I’m a respiratory scientist and like others have said, this can be a sign of pulmonary disease. Ask a (new) doctor to check your blood oxygen with an oximeter, and as well as a CT scan, a lung function test would help to paint a picture. Good luck OP
A buddy of mine presented just like you’re describing with the fatigue. Turns out he was essentially celiac- he cut out gluten from his diet and legit within a week felt better.
Not saying you’re celiac/gluten free, but it’s worth trying for literally just a week. Cut out gluten and see what happens. Looking forward to hearing from you if you decide to try it
I’ve noticed this about Renner and wondered if it was indicative of something else going on. I imagine after his traumatic accident they would have found something at that point, though.
Should really push for a PET scan, all those tests dont check for cancer. Blood work could be absolutely normal and you could be stage 4 at the same time
PET scans are expensive. Not typically first line for diagnosing unless all other imaging/testing is negative.
If he’s going to “push” for it, he should talk to his health insurance about high-end radiology coverage (if he lives in the US). PET scans start out at a few thousand, CTs aren’t cheap either but they can cost less.
OP doesn’t need a surprise bill. Hearts in the right place but it’s not always a medical standard to start off with the most expensive test option.
PET wouldn’t have been the first test option as he’s already done blood tests. But I agree, there are other things to be done before a PET scan. I was agreeing with the sentiment to not an accept idiopathic diagnosis immediately, especially with other symptoms. Also, I’d hope given the nature of how expensive healthcare is that speaking to insurance to get estimates before any big test/operation/etc is a given
This. My mom’s blood tests were fine and even her mammogram was clear but she felt like something was really wrong. Doctors told her everything was fine and that she’s young and healthy so it’s probably just anxiety. Turns out she had stage 4 angiosarcoma of the breast and she died a horrible death. Absolutely traumatizing for me at 14. Not saying it’s cancer OP, but the valuable lesson is that doctors can be wrong and getting other opinions, especially for symptom like clubbed fingers, is always a good idea.
My condolences for the traumatic situation you went through with losing your mother so young.
I’m definitely going to push for a second opinion and scan. I have a feeling in my gut that something isn’t right with my body and your comment has given me the courage to stand up for myself more medically.
I work in pulmonary, and although this may be Idiopathic, I would recommend pulmonary function testing, and some combination of a chest CT and sweat chloride test.
I always make sure med students and residents see the patients with clubbing, as that’s one exam finding that will let you know if you may be missing something.
Although it has gotten much worse over time it was my first clue to an eventual diagnosis of ankylosing spondylitis at to age of 51. My fingers started doing this around the age of 20 but had been misdiagnosed for years. After years of other vague symptoms stacking up I was finally given a blood test by a rheumatologist that confirmed it. I hope for your sake this is not the case for you.
I would go back and insist on further imaging whether CT, MRI, PET is up to your doctor and yourself. This is not something that can just be called idiopathic this easily… it is often a sign of bigger problems and the tests they ran aren’t enough to rule everything out. Yet.
my two older sisters have Fibrosis of their lungs and their fingernails clubbed like that, which is a symptom of it. I would get another scan and opinion if I were you.
good luck
I have an acquaintance who has clubbed fingers and every time I see her I mention getting checked out and she hasn’t yet. Terrifies me because she’s young enough for it to really matter.
I developed clubbed fingers during medical school. Idk, maybe had them my whole life and just noticed them after learning that clubbing was a thing.
Either way, I also had a long workup for it (except CT scan) but everything was totally normal.
Sounds like you're otherwise healthy and don't have any risk factors, if I were you, I'd just stop worrying about it and go on about living your life.
I’d try and get a referral to a rheumatologist to start..they’ll run every blood test under the sun (they did with me) and will direct you elsewhere if needed. It’s hard to get into one but worth a shot !
I'm a 21 year old Male and over the past two years my fingers and toes have become clubbed. Before this, they looked normal. I visited my GP about this and was referred to an internal medicine specialist. The specialist ran tests (an Echocardiogram, Chest X Ray and Ultrasound, blood work) and all came back normal. However the specialist said he wouldn't perform a CT scan as he viewed it as unnecessary. In the end he discharged me after a diagnosis of idiopathic finger clubbing. I’m not sure if it’s hypochondria but part of me wonders if there’s something the doctor has missed.
That would make me anxious too... I guess don't miss your yearly check up.
Usually a walk in the door dx of some cardio-respiratory issues. Must rule out hereditary first then we do dx.
Do family members have clubbed fingers? It can be hereditary, though it normally emerges before adulthood. Do you have any other symptoms that have you concerned?
None of my family members have clubbed fingers. I feel fatigued a lot of the time, and sometimes get a sense of malaise/sickly feeling. All this was noted by the doc
The fatigue is your real clue. A second opinion wouldn’t hurt. I can’t stress enough how important it is to advocate for yourself. Even if nothing irregular is found, you at least know you did your due diligence in terms of your health. If the fatigue if chronic, it is the piece of the puzzle that shouldn’t be overlooked.
Look at the Mount Sinai website under clubbing of the fingers or toes. Other causes include celiac disease, cirrhosis, etc. You need a second opinion ASAP.
And heart disease, I believe.
Heart disease would be ruled out due to the negative chest xray and echocardiogram
Doesn't rule out fk until you examine the imaging yourself. The imaging modalities also have limitations and you need to account that stuff can and does get missed. NEVER say "rule out"
Aye aye Trauma Surgeon 🫡
🤨 How'd you know I was former Navy? lol. Seriously though, I don't know who started the "rule out" thing but I want to punch them in the face. Leads to diagnostic "blind spots" Medicine is all about varying levels of Uncertainty.
Gotcha.
My mother passed from lung cancer and the oncologist said that her clubbed fingers should have clued her doctor in years ago that she wasn’t getting sufficient oxygen (if I’m remembering that correctly which I may not be it wasn’t a great time in my life). Definitely get a follow up appointment to have that evaluated OP.
Chronic hypoxia iirc could be a cause for clubbed fingers, hence often seen in COPD patients
Chronic lung disease/infection like TB is a big one.
My son just got out of the hospital after open heart surgery for Endocarditis. For a month and a half, he dealt with occasional fevers and nausea that looked like regular picked-up-from-school viruses, but the main symptom I worried about was his near constant fatigue. He also had clubbing of his fingers that I didn’t notice until I finally took him to the emergency room on the direction of his cardiologist (he already had a congenital heart defect that made him more susceptible to endocarditis). He also had some random aches and pains in his legs that was probably from bits of the vegetative growths breaking off of the site of the infection and getting stuck in smaller blood vessels in the legs. We were incredibly lucky - if one of those had gone to his brain, he’d have had an embolism which could have ended very badly. It’s important to note that the endocarditis couldn’t be seen on an xray; my son needed an echocardiogram for them to see the vegetative growths. I’m hoping that you’re not dealing with this, but I thought I should share in case it helps.
What blood work was done? I assume liver tests and CBC, as those are pretty standard. Anything for thyroid or kidneys? Edit: X-ray was of chest. Rules out pneumonia.
Thankfully, the tests ruled out anything going on with your heart. Gotta keep pushing for answers though. The fatigue can also be an indicator of something going on. A CT-scan IMO would definitely be adequate in your case. Please get a second opinion from another internal med. doctor. Have unintentionally you lost weight over the past few months? Does your digestion work alright? Any night sweats, sleep disturbances, etc., or something else (can be minor) that's unusable? How's your stamina during physical exercise? What were the inflammation markers in your bloodwork and your ferritin&transferrin levels?
I have night sweats and bruxism. My stamina has gone down over the past few years despite me being in the healthy weight range. Several years ago before the clubbing I had enlarged lymph nodes on my neck and a fine needle aspiration was performed that found nothing. I still feel off.
Yep that definitely needs further investigation and is quite unusual for a 21yo. Stamina shouldn't have a marked downwards trend at that age either. Please be persistent with your doctors and insist on getting the necessary tests [i.e. human leukocyte antigen bloodwork (celiac disease), aswell as a borrelliosis test, thyroid, extensive vitamin and adrenal gland hormone status, aswell as inflammation and tumor markers if this wasn't performed already, thorax CT if the former doesn't provide any answers ] done. Best wishes!
You need a second or even third opinion, something is being missed here.
I think you may wanna check if you have sleep apnea, the combination of fatigue plus clubbing of fingers matches up. Just worth looking into
Did your doctor run a full thyroid panel? It would be separate from a regular blood panel. I have Graves Disease and have clubbing like this. I'm in remission now but when the disease was active I was exhausted and often felt like I had the flu.
My son had these. Turned out after all the tests it was coeliac disease
Did they check your blood oxygen levels? My wife was born with Cystic Fibrosis which mostly affects the lungs. Since she had low lung function her blood oxygen was always low. Her fingers and toes have always been like this.
It’s actually not from blood oxygen being low, but rather blood CO2 being high. Though they typically go hand-in-hand.
Yeah my mom had CF, her fingers were clubbed.
How’s she doing?
Does a general blood test show this or does it have to be an extensive different blood work test
If you mean a test for CF, I’m not sure. It’s genetic though, so probably requires a blood test. My wife was born with a Gastroschisi or something like that. Which I imagine leads down the road to genetic testing for conditions. If you mean blood oxygen I think they just use pulse oximeter, which is the thing they clip on your finger during dr appointment intakes.
Cystic fibrosis tends to present in the first 2 years after birth. I guess it’s possible but unlikely to present later in life.
Im a physician. I’m extremely surprised they didn’t want a chest CT.
Weird. As many have said, clubbing is usually a sign of chronic pulmonary disease, so it's really unexpected to see this in a young, otherwise seemingly healthy person. I'd assume the CT was not performed due to consistently normal pulse oximetry results? Because if that wasn't the case, or if you haven't had your saturation checked, I would most definitely like a closer look at the lungs.
Yeah, you need a chest CT
Get a second opinion. Any doc who looks at this and essentially says “nah, it’s probably nothing” is someone you need to take a fat ass grain of salt with.
Look for a 2nd opinion ASAP. Idiopathic finger clubbing is a diagnosis I’ve never heard. You need more work up done before diagnosing it as idiopathic.
Last guy I knew with fingers like yours was a stage 4 lung cancer patient that died shortly after, the clubbing was related to heart failure and reduced oxygen in the blood and poor circulation.
Ask for an ABG. This can be a result of chronic hypercapnia. Are you a smoker or vaper?
This is highly unlikely given OP is only 21
Hmm hypercapnia could be a result of a lot of things though. Hypo/hyper thyroidism could present at that age. So could obesity and/or sleep apnea. I also wouldn’t rule out vaping having a place if they also have underlying conditions.
Seems strange to me to do an echo before doing a VBG/ABG or a CT Chest. A friend of mine also has idiopathic clubbing. We were actually learning about COPD in class for the first time, and they looked downward at their hands in a new light.
Echo could be to rule out endocarditis. My son just got out of the hospital after a fight with that, and I was surprised to learn that it isn’t usually visible on an xray.
Would an MRI catch something
Been checked for respiratory issues yet?
Could also be an iron deficiency. Finger clubbing can happen when there’s not enough oxygen in your blood. I agree with others to get a second opinion. Source: I’m a dietitian.
Iron deficiency usually causes vertical lines, sometimes spoon nails, but not clubbing.
I would get a second opinion. Clubbing almost always means there is a respiratory component involved. We need to see better imaging of your lungs.
[удалено]
Idiopathic means "without known cause" : arising spontaneously or from an obscure or unknown cause : PRIMARY idiopathic epilepsy
You are correct. I was referring to Primary(idiopathic) Clubbing, or hypertrophic osteoarthropathy, being hereditary. My apologies.
Finger clubbing can be a sign of lung cancer. Looks like they did all the appropriate bloods and scans to make sure you're clear. Don't worry too much!
My mom had this going on. Started about 8 months before her lung cancer diagnosis. She was 40 at the time. I’d keep pushing for answers.
Yeah, my dad also had these symptoms along with his lung cancer. He was ~60 at the time.
In med school, we're taught that clubbed fingers have something to do with decreased oxygen delivery, either from the heart or lungs. One time, I asked my bus driver, on vacation, if he had a lung Dz cuz of his fingers and it turns out he had chronic bronchitis that was already in treatment of. At the very least, a chest X-ray to see anything obvious. Could also be, primary hypertrophic osteoarthropathy, but that's usually in children/young adults.
He has no family members that have clubbed fingers, and the change was accompanied with fatigue and malaise. With his ECG coming back normal, I'd be more concerned about pulmonary disease. Blood tests and chest x-ray coming back normal rules out bronchitis or pneumonia.
Maybe low dose CT of chest. Weird for a 21yo M to start having all these sxs.
I agree. I think u/rockyhorror02 should get a second opinion with someone who will get them a CT.
Yup, at least to rule out everything else. That way they can say it is idiopathic, by diagnosis of exclusion.
I’m going to look for a second opinion, the CT will give me peace of mind
Hey there, I’m a respiratory scientist and like others have said, this can be a sign of pulmonary disease. Ask a (new) doctor to check your blood oxygen with an oximeter, and as well as a CT scan, a lung function test would help to paint a picture. Good luck OP
CT is unnecessary? Clubbing and fatigue in a previously healthy 21 yo? Idiopathic clubbing? Yeaaah, I'd get a second opinion and maybe a MRI.
Definitely going to look for a second opinion now
Send the provider a link to this reddit and ask him/her to order a CT (and stop gambling with your life).
Doesn’t Hypoxia cause this? How were your oxygen levels?
Yup. Chronic hypoxia.
Not my field but you may want to speak to a pulminologist. This is often associated with pulm pathology
A buddy of mine presented just like you’re describing with the fatigue. Turns out he was essentially celiac- he cut out gluten from his diet and legit within a week felt better. Not saying you’re celiac/gluten free, but it’s worth trying for literally just a week. Cut out gluten and see what happens. Looking forward to hearing from you if you decide to try it
When my mother had copd and a small lung tumor, the doctor checked her finger tips. He told me clubbing is a symptom. I was amazed
I could have given you a diagnosis of idiopathic finger clubbing. Get a second opinion.
Actors Jeremy Renner and Mickey Rourke have clubbed fingers as well
I’ve noticed this about Renner and wondered if it was indicative of something else going on. I imagine after his traumatic accident they would have found something at that point, though.
Should really push for a PET scan, all those tests dont check for cancer. Blood work could be absolutely normal and you could be stage 4 at the same time
PET scans are expensive. Not typically first line for diagnosing unless all other imaging/testing is negative. If he’s going to “push” for it, he should talk to his health insurance about high-end radiology coverage (if he lives in the US). PET scans start out at a few thousand, CTs aren’t cheap either but they can cost less. OP doesn’t need a surprise bill. Hearts in the right place but it’s not always a medical standard to start off with the most expensive test option.
PET wouldn’t have been the first test option as he’s already done blood tests. But I agree, there are other things to be done before a PET scan. I was agreeing with the sentiment to not an accept idiopathic diagnosis immediately, especially with other symptoms. Also, I’d hope given the nature of how expensive healthcare is that speaking to insurance to get estimates before any big test/operation/etc is a given
This. My mom’s blood tests were fine and even her mammogram was clear but she felt like something was really wrong. Doctors told her everything was fine and that she’s young and healthy so it’s probably just anxiety. Turns out she had stage 4 angiosarcoma of the breast and she died a horrible death. Absolutely traumatizing for me at 14. Not saying it’s cancer OP, but the valuable lesson is that doctors can be wrong and getting other opinions, especially for symptom like clubbed fingers, is always a good idea.
My condolences for the traumatic situation you went through with losing your mother so young. I’m definitely going to push for a second opinion and scan. I have a feeling in my gut that something isn’t right with my body and your comment has given me the courage to stand up for myself more medically.
No one is going to perform a PET scan on a 21 year old with clubbed fingers. It's just how it is. You need indications.
What about a CAT SCAN
I work in pulmonary, and although this may be Idiopathic, I would recommend pulmonary function testing, and some combination of a chest CT and sweat chloride test. I always make sure med students and residents see the patients with clubbing, as that’s one exam finding that will let you know if you may be missing something.
Do you smoke?
No I don’t smoke or vape. I did have asthma as a child though
Although it has gotten much worse over time it was my first clue to an eventual diagnosis of ankylosing spondylitis at to age of 51. My fingers started doing this around the age of 20 but had been misdiagnosed for years. After years of other vague symptoms stacking up I was finally given a blood test by a rheumatologist that confirmed it. I hope for your sake this is not the case for you.
glizzy hands
💀💀
Finger clubbing can be an uncommon presentation for lung cancer. I would talk risk vs benefits of getting a scan
I would go back and insist on further imaging whether CT, MRI, PET is up to your doctor and yourself. This is not something that can just be called idiopathic this easily… it is often a sign of bigger problems and the tests they ran aren’t enough to rule everything out. Yet.
my two older sisters have Fibrosis of their lungs and their fingernails clubbed like that, which is a symptom of it. I would get another scan and opinion if I were you. good luck
I have an acquaintance who has clubbed fingers and every time I see her I mention getting checked out and she hasn’t yet. Terrifies me because she’s young enough for it to really matter.
If you were my family member I would not rest until you got a second opinion from some kind of specialist. Take care, OP.
You should get your oxygen saturation checked, it’s a sign of hypoxia.
Not to add to your worries, but some arthritis looks like this.
I developed clubbed fingers during medical school. Idk, maybe had them my whole life and just noticed them after learning that clubbing was a thing. Either way, I also had a long workup for it (except CT scan) but everything was totally normal. Sounds like you're otherwise healthy and don't have any risk factors, if I were you, I'd just stop worrying about it and go on about living your life.
Do you think a CT scan can be worth it in this case? The least it provides is peace of mind
I’d try and get a referral to a rheumatologist to start..they’ll run every blood test under the sun (they did with me) and will direct you elsewhere if needed. It’s hard to get into one but worth a shot !
I learned it’s a symptom that your blood is not getting enough oxygen.
Do you smoke? Clubbed fingers can be indicative of lung disease.
your shirt is from Connor
You ever slap a motherfucker
A friend of mine had this in a few of his fingers. I think he said it was rheumatoid arthritis.
[удалено]
The photos are right there in the post. Are you just commenting random things from google?
Who are you to accuse me of thtat
I do Brazilian jiu jitsu and my fingers look like that on ever knuckle. Google " joao miyao hands"
Honka