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. 

Pathology

Etiology

Common causes 2:

Uncommon causes 2:

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.

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Article information

rID: 2041
Section: Gamuts
Synonyms or Alternate Spellings:
  • Short fourth metacarpals
  • Short fourth metacarpal
  • Shortened fourth metacarpal
  • Short 4th and 5th metacarpals
  • Short 4th / 5th metacarpal

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Cases and figures

  • Figure 1: positive metacarpal sign
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  • Case 1: post-traumatic
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  • Figure 2: negative metacarpal sign
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  • Case 2: positive metacarpal sign
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  • AP radiograph
    Case 3: isolated unilateral shortened 5th metacarpal
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  • Case 4: Turner syndrome
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  • Case 5: Turner syndrome - hand
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  • Case 6: bilateral short 5th metacarpals
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  • Short 4th metacar...
    Case 7: short fourth metacarpal
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  • Short 4th/5th met...
    Case 8: short 4th/5th metacarpal
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  • Case 9: short 5th metacarpal
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