Presentation
Soft tissue infection around the right index finger proximal interphalangeal joint. Osteomyelitis?
Patient Data
Loss of bone stock in the radial aspect of the index finger proximal phalanx with cortical destruction. In the context of infection and associated soft tissue swelling, this could represent represent osteomyelitis. However, this appearance commonly represents subperiosteal resorption secondary to hyperparathyroidism - correlation with serum parathyroid levels advised.
Case Discussion
The patient went on to have surgical debridement of soft tissue infection in the area, with no intra-operative evidence of osteomyelitis. Serum parathyroid levels were raised (9.8 pmol/L - normal range 1.6-7.5).
Subperiosteal bone resorption secondary to hyperparathyroidism is commonly seen in the radial aspect of the index and middle fingers, as demonstrated here.