A 50-year-old woman developed severe burning pain, hyperaesthesia, and swelling of the right hand 8 weeks after a conservatively treated Colles' fracture. The skin is glossy and the fingers are stiff. X-ray shows patchy demineralisation of the carpus and hand. The MOST characteristic radiographic finding described here is:

• A Subperiosteal bone resorption of the radial aspect of middle phalanges
• B Patchy spotty osteoporosis of the periarticular bones ✓
• C Cortical thickening with trabecular coarsening
• D Punched-out lytic lesions of the metacarpal heads

Explanation

Complex regional pain syndrome type I (Sudeck's atrophy) after limb trauma produces patchy, spotty periarticular osteoporosis on X-ray, classically described as resembling punched-out spots but diffuse rather than discrete lesions. Subperiosteal resorption of radial aspects of phalanges is seen in hyperparathyroidism. Cortical thickening with coarse trabeculae suggests Paget disease. Management is early physiotherapy, analgesia and sometimes sympathetic blockade.

Reference: Apley and Solomon's Concise System of Orthopaedics and Trauma, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.