Bone Lesions

Abstract

Bone lesions in the hand may be classified into generalized, multiple, and solitary lesions. Generalized lesions include acromegaly, rickets, and thalassemia major. Acromegaly produces distal phalangeal tuft widening, with spade-like bone spurs. Rickets typically manifest in young children, with prominent changes seen at growing ends of the bones such as growth plate widening and metaphyseal cupping. In thalassemia major there is widening of the bone medulla with cortical thinning and features of osteoporosis. Multiple lesions may be due to acro-osteolysis, enchondromatosis, geodes, melorheostosis, and sarcoidosis, In acro-osteolysis, there is lytic destruction of the distal phalanges. Patients with enchondromatosis usually present in early childhood with hand and foot deformities. The most important complication of enchondromatosis is sarcomatous transformation. Also known as subchondral cysts, geodes are usually seen as well-defined osteolytic lesions with marginal sclerosis. Melorheostosis involves at least two adjacent bones in a monomelic distribution, with cortical thickening due to periosteal and endosteal new bone formation. A reticulated lace-like trabecular pattern in the middle and distal phalanges and metacarpals is typically found in sarcoidosis. Solitary lesions include bone island, brown tumor, enchondroma, giant cell tumor, hemangioma, metastasis, and Paget’s disease.