Findings

–Atrophy and tapering of soft tissues of fingers

–Acroosteolysis

–Subcutaneous Ca+ or joint Ca+

–Erosions (late finding) with predilection for PIP and DIP

–Flexion contractures

–Very distinctive feature is severe resorption of 1st carpometacarpal joint with radial subluxation of the 1st metacarpal

DDx soft tissue Ca+ in hands:

  • hyperparathyroidism, scleroderma, burns, SLE, dermatomyositis

DDx acroosteolysis (“PINCHFO”)

  •  –Psoriasis, pyknodysostosis
  • –Injury: thermal burn, frostbite
  • –Neuropathy: diabetes, leprosy
  • –Collagen vascular: scleroderma, Raynaud
  • –Hyperparathyroidism
  • –Familial: Hadju-Cheney
  • –Other: polyvinyl chloride exposure, progeria