Coned epiphyses can be a normal variation in the hand in the general population, most commonly affecting the 5th middle and 1st distal phalanges. However, it can also be associated with a number of conditions.  The differential diagnoses can be summarized with the mnemonic, ABCD MOST: 

• achondroplasia, acrodysostosis
• beckwith-Wiedemann syndrome 
• chondroplasia punctata, Cockayne syndrome, conorenal syndrome (Mainzer-Saldino Syndrome, associated with chronic renal failure and phalangeal coned epiphyses of the hands), cleidocranial dysplasia, cartilage-hair hypoplasia 
• dactylitis, Dyggve-Melchior-Clausen syndrome
• multiple epiphyseal dysplasia
• osteomyelitis 
• sickle cell disease 
• thermal injury, trichorhinophalangeal syndrome

This case was submitted with supervision and input from:

Soni C. Chawla, M.D.
Associate Professor
Department of Radiological Sciences
David Geffen School of Medicine at UCLA
Olive View - UCLA Medical Center