Rheumatoid arthritis

Case contributed by Hani Makky Al Salam
Diagnosis probable
x-ray

Hitchhiker's thumb and swan-neck deformities of multiple fingers. Subluxation of the metacarpophalangeal joints with telescoping of some. Advanced degeneration of the carpus. 

Case Discussion

Radiographic features of rheumatoid arthritis of the hand include:

  • periarticular osteoporosis, subluxation, dislocation and erosions
  • metacarpophalangeal ulnar deviation
  • Boutonniere deformity: hyperextension of DIP, flexion of PIP
  • swan-neck deformity: hyperextension of PIP, flexion of DIP
  • hitchhiker's thumb
  • telescope fingers: shortening of phalanges due to dislocations
  • ulnar and radial styloid erosions are common
  • wrist instability: ulnar translocation, scapholunate dissociation

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