BONES OF HAND- METACARPAL

All the metacarpals in the hand have one epiphysis per bone which is in the head of the bone except the thumb, where it is in the base

D i.e. 1^st

Answer is A (Psoriatic arthropathy):

Psoriatic arthritis involves PIP, DIP and metacarpophalangeal joints, and may or may not involve the wrist.

• Involvement of DIP makes rheumatoid arthritis unlikely. DIP is spared in rheumatoid arthritis.
• Involvement of metacarpophalangeal joints makes osteoarthritis unlikely. Metacarpophalangeal joints and carpometacarpal joint with the exception of base of thumb are spared in osteoarthritis.

Answer is D (Osteoarthritis) :

Sparing of wrist and metacarpophalangeal joint with involvement of base of thumb (i.e. carpometacarpal joint) is very characteristic of `osteoarthritis’.

Both DIP (Herbeden’s nodes) and PIP (Bouchard’s nodes) are involved in osteoarthritis.^Q

DIP is the most common form of idiopathic O.A.

Answer is A (Osteoarthritis)

Answer is A (Pseudohypoparathyroidism):

The presence of hyperphosphatemia (Serum phosphate) along with characteristic brachydactyly suggests the diagnosis of pseudohypoparathyroidism.

Pseudohypoparathyroidism

• This is a hereditary disorder associated with symptoms and signs of hypoparathyroidism despite an elevated PTH level (pseudohypoparathyroidism)
• This is produced as a result of deficient end organ response to PTH.

Answer is B (Turner’s Syndrome) :

Noonan syndrome presents with most features similar to Turner’s Syndrome. Webbing of neck, increased carrying angle, low hair line are present in both Noonan’s and Turner’s Syndrome but short fourth metacarpal is characteristic of Turner’s Syndrome only.

Term Noonan syndrome has been applied to males and females who present with phenotypic features of Turner’s Syndrome but have a normal Karyotype (46X, Y or 46 XX)

Ans. Turner syndrome

Ans. 5.4 to 7.9

 Saddle

Ans. is ‘a’ i.e., Osteoarthritis

1st Carpometacarpal joint Wrist- Osteoarthritis

Ans. is ‘b’ i.e., Saddle

Ans. is `c’ i.e., Pseudohypoparathyroidism

Shortening of the fourth/fifth metacarpals/metatarsals

• Shortening of the fourth/fifth metacarpals and less commonly metatarsals is seen in a variety of apparently disparate conditions. 

Etiology

Common causes :

• idiopathic
• post-infective (e.g. osteomyelitis, yaws, tuberculosis dactylitis)
• pseudohypoparathyroidism/pseudopseudohypoparathyroidism
• post-traumatic (acute or chronic/healed and particularly those involving growth plate)
• Turner syndrome

Uncommon causes :

• basal cell nevus syndrome (Gorlin syndrome)
• hereditary multiple exostosis syndrome 
• 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 .

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.