what i can spot - Z deformity of the thumb - "Z-thumb" or "Z-deformity" consists of hyperextension of the interphalangeal joint (BOUTONNIERE DEFORMITY)+ flexion and subluxation of the metacarpophalangeal joint and gives a "Z" appearance to the thumb. - total subluxation of MP joint at index and middle finger (so ulnar deviation is not that evident). - ulnar deviation of MP joints at ring and little finger - BOUTONNIERE + SWAN Neck of ring finger all of the above + the osteoarthritc changes seen at most joints i.e joint space narrowing, subchondral sclerosis and bone loss ( i didn't spot any osteophytes..but i am sure they will b evident on better resolution X ray. My Diagnosis Preface - although each of these individual changes can be seen in osteoarthritis. Such a grand coming together will be seen classically in Rheum. Arthritis ! X ray of hand of a person with rheumatoid Arthritis. (-:
