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Differential Diagnosis of Musculoskeletal Disorders

Benign Lesion of Finger!!navigator!!

  1. cartilage matrix
    1. Enchondroma
    2. Enchondromatosis
    3. Periosteal / juxtacortical chondroma
    4. Chondromyxoid fibroma
    5. Chondroblastoma
  2. bone matrix
    1. Osteochondroma
    2. Hereditary multiple exostoses
    3. Subungual exostosis
    4. Florid Reactive Periostitis
    5. Bizarre parosteal osteochondromatous proliferation
    6. Osteoid osteoma
    7. Aneurysmal bone cyst
    8. Giant cell tumor
  3. mimics of primary osseous lesion
    1. Glomus tumor
    2. Epidermal inclusion cyst
    3. Systemic disease: sarcoidosis, tophaceous gout, brown tumor of hyperparathyroidism, rheumatoid arthritis ± pressure erosion from overlying rheumatoid nodule
    4. Infection

Lucent Lesion in Finger!!navigator!!

  1. BENIGN TUMOR
    1. Enchondroma
    2. Epidermoid inclusion cyst
    3. Giant cell tumor
    4. Reparative granuloma
    5. Sarcoidosis
    6. Glomus tumor (rare)

    others: aneurysmal bone cyst, brown tumor, hemophilic pseudotumor, solitary bone cyst, osteoblastoma
  2. MALIGNANT PRIMARY TUMOR (exceedingly rare)
    1. osseous malignancy
      1. Chondrosarcoma
        • Most common primary malignant bone tumor of the hand!
      2. Osteosarcoma
      3. Fibrosarcoma
      4. Hemangioendotheliosarcoma
      5. Ewing sarcoma
    2. nail bed malignancy
      1. Squamous cell carcinoma
      2. Malignant melanoma
  3. MALIGNANT SECONDARY TUMOR
    1. Metastasis from lung >genitourinary tract >breast

mnemonic: GAMES PAGES

  • Glomus tumor
  • Arthritis (gout, rheumatoid)
  • Metastasis (lung, breast)
  • Enchondroma
  • Simple cyst (inclusion)
  • Pancreatitis
  • Aneurysmal bone cyst
  • Giant cell tumor
  • Epidermoid
  • Sarcoid

Dactylitis!!navigator!!

= expansion of bone with cystic changes

  1. Tuberculous dactylitis (= spina ventosa)
  2. Pyogenic / fungal infection
  3. Syphilitic dactylitis
  4. Sarcoidosis
  5. Hemoglobinopathies
  6. Hyperparathyroidism
  7. Leukemia

Resorption of Terminal Tufts!!navigator!!

  1. TRAUMA
    1. Amputation
    2. Burns, electric injury
    3. Frostbite
    4. Vinyl chloride poisoning
  2. NEUROPATHIC
    1. Congenital indifference to pain
    2. Syringomyelia
    3. Myelomeningocele
    4. Diabetes mellitus
    5. Leprosy
  3. COLLAGEN-VASCULAR DISEASE
    1. Scleroderma
    2. Dermatomyositis
    3. Raynaud disease
  4. METABOLIC
    1. Hyperparathyroidism
  5. INHERITED
    1. Familial acroosteolysis
    2. Pyknodysostosis
    3. Progeria = Werner syndrome
    4. Pachydermoperiostosis
  6. OTHERS
    1. Sarcoidosis
    2. Psoriatic arthropathy
    3. Epidermolysis bullosa

Subungual Tumors!!navigator!!

  1. Benign solid tumor
    1. Glomus tumor
    2. Subungual exostosis
    3. Soft-tissue chondroma
    4. Keratoacanthoma
    5. Hemangioma
    6. Lobular capillary hemangioma
  2. Benign cystic lesion
    1. Epidermal cyst
    2. Mucoid cyst
      = cyst containing hyaluronic acid + related to osteoarthritis of DIP joint
  3. Malignant tumor
    1. Squamous cell carcinoma
    2. Malignant melanoma

Acroosteolysis!!navigator!!

  1. Acroosteolysis:
    1. acquired
    2. familial
  2. Massive osteolysis
  3. Essential osteolysis
  4. Ainhum disease

Acquired Acroosteolysis

mnemonic: PETER's DIAPER SPLASH

  • Psoriasis, Porphyria
  • Ehlers-Danlos syndrome
  • Thrombangiitis obliterans
  • Ergot therapy
  • Raynaud disease
  • Diabetes, Dermatomyositis, Dilantin therapy
  • Injury (thermal + electrical burns, frostbite)
  • Arteriosclerosis obliterans
  • PVC (polyvinyl chloride) worker
  • Epidermolysis bullosa
  • Rheumatoid arthritis, Reiter syndrome
  • Scleroderma, Sarcoidosis
  • Progeria, Pyknodysostosis
  • Leprosy, Lesch-Nyhan syndrome
  • Absence of pain
  • Syringomyelia
  • Hyperparathyroidism
  • also in: yaws; Kaposi sarcoma; pachydermoperiostosis
  • lytic destructive process involving distal + middle phalanges
  • NO periosteal reaction
  • epiphyses resist osteolysis until late

Acroosteosclerosis!!navigator!!

= focal opaque areas + endosteal thickening

  1. Incidental in middle-aged women
  2. Rheumatoid arthritis
  3. Sarcoidosis
  4. Scleroderma
  5. Systemic lupus erythematosus
  6. Hodgkin disease
  7. Hematologic disorders

Fingertip Calcifications!!navigator!!

  1. Scleroderma / CREST syndrome
  2. Raynaud disease
  3. Systemic lupus erythematosus
  4. Dermatomyositis
  5. Calcinosis circumscripta universalis
  6. Hyperparathyroidism

Outline