The patient presented with a painful left index finger after a trivial sport-related injury. AP and lateral views of the left index finger and subsequently an AP view of the left hand were performed.
The patient presented with a painful left index finger after a trivial sport-related injury. Initially AP and lateral views of the left index finger were performed. After initial inspection of these views it was decided to obtain an AP view of the whole of the left hand including the wrist. On examination the patient had full range of movement and no skin abnormalities were detected.
Both the dedicated views of the left index finger and the radiograph of the left hand demonstrated irregular endosteal linear areas of increased density along the major axis of the 2nd and 3rd metacarpals and the 1st, 2nd and 3rd proximal phalanges. These were encroaching on the medulla, but were primarily cortically based. The adjacent epiphyses were also involved to varying degrees. Additionally, there was almost complete sclerosis of the 2nd and 3rd middle and distal phalanges and their epiphyses. There were also irregular areas of sclerosis in the lunate, trapezoid and capitate. Joint fusion, shortening of the involved bones or ossified soft tissue masses were not seen. Unfortunately, no radiographs of the contralateral hand were available for comparison.
The appearances are consistent with melorheostosis.
Melorheostosis is a non-genetic disease of unknown aetiology. It is usually unilateral, asymmetrical and the most common site is in the diaphyses of the lower limb. Sclerotic linear streaks along the long axis of the affected bone, which are often likened to "dripping candle wax", are seen. The epiphyses may also be affected. Soft tissue calcification and ossification with a periarticular predisposition may occur. Melorheostosis can be asymptomatic but may also present with pain, soft tissue contracture and indurating skin lesions. In this patient the finding may be incidental and her pain attributed to soft tissue injury, or the pain may be due to the melorheostosis. Time will tell!
Melorheostosis
The patient is a 10-year-old female who reported pain in her left index finger following minor trauma during physical activities. An anteroposterior and lateral X-ray examination of the left index finger and left hand was performed, revealing the following main radiographic features:
Overall, the sclerotic changes appear in a band-like distribution, consistent with classic linear sclerotic findings.
Given its radiographic features, its more common occurrence in the lower limbs (though it can affect upper limbs and smaller bones in the hand), and the possibility of symptomatic or asymptomatic presentation, Melorheostosis remains the primary consideration.
Combining the patient’s age, clinical presentation (localized pain possibly due to minor trauma or the bone lesion itself), and radiological signs (linear sclerosis along the shaft and possibly involving the epiphysis with a “wax-dripping” appearance), the most likely diagnosis is:
Melorheostosis (Localized bone sclerosis syndrome).
For further confirmation, if symptoms persist or worsen, a CT or MRI can be considered to assess soft tissue involvement. If necessary, serum tests or histopathological examinations can be used to exclude other rare sclerotic bone diseases.
In this case, if the pain primarily stems from minor trauma or soft tissue strain, the following conservative and observational management strategies can be adopted initially:
Rehabilitation and Exercise Prescription Suggestions (following the FITT-VP principle, gradual progression, and individualized approach):
If pain worsens or new symptoms arise, timely re-evaluation or consultation with an orthopedic specialist and rehabilitation physician is advised to adjust the plan.
This report is provided as a reference-based analysis only and does not replace in-person consultations or professional medical opinions. Should you have any concerns or changes in symptoms, please consult a specialist or seek further evaluation at a recognized medical institution.
Melorheostosis