Case of the Week: March 31-April 7, 2011

Finding and two or three differential diagnosis for the finding?

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Case Details

Study demonstrates shortened 4th and 5th metacarpal bones.

Answer

Diagnosis: Short fourth and fifth metacarpals-Idiopathic

When a line is drawn along  the heads of the 4th and 5th metacarpals, it should not intersect the  3rd metacarpal.  If it does the 4th metacarpal is shortened.

These bones can be shortened in a number of conditions, the most common of which is idiopathic as in this case.

Up to 9.6% of the population has this finding.

Shortened 4th and 5th metacarpals also occur in a number of conditions such as post-traumatic/post-infectious, Turner syndrome, pseudohypoparathyroidism, pseudopseudo- hypoparathyroidism, Basal cel nevus(Gorlin) syndrome, Sickle cell disease with infarction, Hereditary multiple exostosis and homocystinuria.

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