Journal of Musculoskeletal Surgery and Research

RADIOLOGY QUIZ
Year
: 2019  |  Volume : 3  |  Issue : 3  |  Page : 315--316

Short painful fingers


Nizar A Al-Nakshabandi 
 Department of Radiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia

Correspondence Address:
Dr. Nizar A Al-Nakshabandi
Department of Radiology, College of Medicine, King Saud University, Riyadh
Saudi Arabia




How to cite this article:
Al-Nakshabandi NA. Short painful fingers.J Musculoskelet Surg Res 2019;3:315-316


How to cite this URL:
Al-Nakshabandi NA. Short painful fingers. J Musculoskelet Surg Res [serial online] 2019 [cited 2019 Nov 12 ];3:315-316
Available from: http://www.journalmsr.com/text.asp?2019/3/3/315/252827


Full Text

 History



A 45-year-old female, who is known to have a connective tissue disease, presented to the clinic complaining of pain in all fingers. On physical examination, fingertips were tender and appeared bulbous. There is shortening of all fingers.

Q1: What are your findings?

Q2: What are the possible causes?

Q3: Can it be in a single digit?

 Findings



The AP [Figure 1]a AP and Oblique [Figure 1]b views of the hands demonstrate bilateral terminal tuft resorption.{Figure 1}

There is no evidence of erosions seen. No evidence of soft-tissue calcification. No joint destruction is seen.

 Diagnosis



Acroosteolysis.

 Pearls and Discussion



Acroosteolysis is tuft resorption or resorption of the distal phalanges. It can also affect the shaft of the distal phalanx.

When the terminal tuft is resorbed, the differential is usually of scleroderma, psoriasis, thermal injury (if it is cold then it is frostbite, if it is from heat then it is from burns or electricity), dermatomyositis can cause it, as can reactive arthritis and juvenile chronic arthritis.

If it is the mid shaft that is reabsorbed, then toxicity from polyvinyl chloride exposure, hyperparathyroidism (look for brown tumors in that case) or the rare Hajdu–Cheney syndrome.

Single-digit reabsorption can occur in trauma cases, glomus tumor of the digit, or epidermoid inclusion cyst.

Metastasis from bronchogenic cancer can give the cookie bite appearance of the terminal tuft. Osteomyelitis can cause tuft resorption as well.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 Further Reading



Miller TT. Bone tumors and tumorlike conditions: Analysis with conventional radiography. Radiology 2008;246:662-74.Avouac J, Guerini H, Wipff J, Assous N, Chevrot A, Kahan A, et al. Radiological hand involvement in systemic sclerosis. Ann Rheum Dis 2006;65:1088-92.Davies S, editor. Chapman and Nakielny's Aids to Radiological Differential Diagnosis: Expert Consult – Online and Print. 6th ed. Chicago, USA: Saunders Ltd.; 2016.