Shortening of the fourth/fifth metacarpals
Updates to Article Attributes
Shortening of the fourth/fifth metacarpals is seen a variety of apparently disparate conditions.
Pathology
Aetiology
Common causes 2:
- idiopathic
- post-infective (e.g. osteomyelitis, yaws, tuberculosis dactylitis)
- pseudohypoparathyroidism/pseudopseudohypoparathyroidism
- post-traumatic (acute and chronic/healed)
- Turner syndrome
Uncommon causes 2:
- basal cell naevus syndrome (Gorlin syndrome)
- hereditary multiple exostosis syndrome 5
- juvenile idiopathic arthritis
- sickle cell disease with secondary infarction
- homocystinuria
- Langer-Giedion syndrome
Isolated shortening of the 5th metacarpals has been recently described in a familial variant of type 1 diabetes mellitus 3.
Radiographic features
Plain radiograph
Hand x-rays readily identify the abnormality, and can be assessed by drawing a line along the heads of the 4th and 5th metacarpals. If this line intersects the head of the 3rd metacarpal then shortening is deemed to be present.
Thus, shortened 4th metacarpal is the key to this finding. It is known as the metacarpal sign. It is important to note that a positive sign can be seen in up to 10% of normal individuals 4.
-<li><a title="Juvenile idiopathic arthritis" href="/articles/juvenile-idiopathic-arthritis">juvenile idiopathic arthritis</a></li>- +<li><a href="/articles/juvenile-idiopathic-arthritis">juvenile idiopathic arthritis</a></li>
-</ul><p>Isolated shortening of the 5<sup>th </sup>metacarpals has been recently described in a familial variant of type 1 <a href="/articles/diabetes-mellitus">diabetes mellitus</a> <sup>3</sup>.</p><h4>Radiographic features</h4><h5>Plain radiograph</h5><p>Hand x-rays readily identify the abnormality, and can be assessed by drawing a line along the heads of the 4<sup>th</sup> and 5<sup>th</sup> metacarpals. If this line intersects the head of the 3<sup>rd</sup> metacarpal then shortening is deemed to be present. </p><p>Thus, shortened 4<sup>th</sup> metacarpal is the key to this finding. It is known as the <a href="/articles/positive-metacarpal-sign">metacarpal sign</a>. It is important to note that a positive sign can be seen in up to 10% of normal individuals <sup>4</sup>.</p>- +</ul><p>Isolated shortening of the 5<sup>th </sup>metacarpals has been recently described in a familial variant of type 1 <a href="/articles/diabetes-mellitus">diabetes mellitus</a> <sup>3</sup>.</p><h4>Radiographic features</h4><h5>Plain radiograph</h5><p>Hand x-rays readily identify the abnormality and can be assessed by drawing a line along the heads of the 4<sup>th</sup> and 5<sup>th</sup> metacarpals. If this line intersects the head of the 3<sup>rd</sup> metacarpal then shortening is deemed to be present. </p><p>Thus, shortened 4<sup>th</sup> metacarpal is the key to this finding. It is known as the <a href="/articles/positive-metacarpal-sign">metacarpal sign</a>. It is important to note that a positive sign can be seen in up to 10% of normal individuals <sup>4</sup>.</p>