Presentation
Chronic hand deformities. No previous imaging or history available at the time of presentation.
Patient Data
There is diffuse osteopenia bilaterally.
There are bilateral, symmetric, metacarpophalangeal (MCP) subluxations and ulna deviation at these joints. This affects the 2nd to the 5th digits. There is also subluxation of the left first MCP joint and to a lesser extent, the right first MCP joint.
There are hook erosions affecting the metacarpal heads bilaterally. This involves the radial sides on the left (typical) and both the radial and ulna sides on the right. There are no soft tissue calcifications.
There are swan neck deformities predominantly on the right. There is a Boutonniere's deformity of the left fifth digit. There is an incidental punctate metallic foreign body adjacent to the right second digit, proximal phalanx.
(There are no additional views available).
Case Discussion
The limited imaging of this elderly patient's hands suggests Jaccoud arthropathy with the typical MCP subluxations, ulna deviation and hook erosions.
There is no contributory or further history to confirm a potential cause of the arthropathy. The differentials include post rheumatic fever/ SLE / psoriatic arthritis / inflammatory bowel disease and malignancy 2.
The subluxations are due to ligamentous laxity in these patients and are correctable with physical manipulation.
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