Hypertrophic osteoarthropathy

Hypertrophic osteoarthropathy is characterised by periosteal reaction involving the diaphysis and metadiaphysis of the long bones of distal extremities without an underlying bone lesion. Clubbing of the fingers is seen most commonly in patients with lung, liver, and gastrointestinal disorders. When associated with a pulmonary condition, it is termed hypertrophic pulmonary osteoarthropathy (HPOA) and when associated with cancer is considered a paraneoplastic syndrome

Hypertrophic osteoarthropathy has been referred to with multiple different terms, including: Pierre-Marie syndrome, Bamberger syndrome, osteoarthropatia hypertrophicaMankowsky syndrome and Hagner syndrome.

It is usually painful and associated with clubbing of the fingers or toes. 

The causes of hypertrophic osteoarthropathy include:

Plain radiograph

Typically seen as long bone metaphyseal and diaphyseal smooth periosteal reaction.

With disease progression, periostitis becomes more prominent or multilayered and extends to the epiphyses 1.

Nuclear medicine
Tc 99m MDP bone scan
  • symmetric linear increase in tracer accumulation along diaphyseal and metaphyseal surfaces of long bones 4

  • "tram-track" appearance 

General imaging differential considerations include:

Consider the differential for a smooth periosteal reaction.

On bone scintigraphy, differentials include:

  • normal variant
    • lateral cortices of the tibiae often appear with a symmetric linear uptake 
  • shin splints
    • can appear similar, but confined to the tibiae
  • chronic venous insufficiency 
    • can cause symmetrical periosteal uptake
    • usually confined to the lower extremities below the knees 
Share article

Article Information

rID: 1479
Section: Gamuts
Synonyms or Alternate Spellings:
  • HPOA
  • Hypertropic pulmonary osteoarthropathy
  • Hypertropic pulmonary osteoarthropathy (HPOA)
  • HOA
  • Hagner syndrome
  • Bamberger syndrome
  • Pierre-Marie syndrome
  • Mankowsky syndrome

Support Radiopaedia and see fewer ads

Cases and Figures

  • Drag
    Case 1
    Drag here to reorder.
  • Drag
    Case 2
    Drag here to reorder.
  • Drag
    Case 3
    Drag here to reorder.
  • Drag
    Case 4
    Drag here to reorder.
  • Drag
    Case 5
    Drag here to reorder.
  • Drag
    Case 6
    Drag here to reorder.
  • Updating… Please wait.
    Loadinganimation

    Alert accept

    Error Unable to process the form. Check for errors and try again.

    Alert accept Thank you for updating your details.