Clinical presentation:
Young adult female arrived with swelling of her hand. The swelling had been present for some weeks, gradually becoming worse with some pain. She came from a community, who were originally from the Indian sub-continent.

There is a destructive process in the head of the metacarpal of the middle finger. It involves the newly fused epiphysis and extends into the metaphysis, particularly over the cortex with periosteal elevation and laminar priosteal newbone reaction. The articular surfaces appear intact (just!) and the joint space is not widened.

Osteosarcoma,
Lytic metastasis
myelomatosis
and Histiocytosis X,
are not common in the hands, but are listed, for completeness.