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Musculoskeletal Imaging

Tuft

a small small clump or cluster, such as the expansion of bone at the end of a phalanx. The phalangeal (or ungual) tufts may be affected in various musculoskeletal disorders.

In psoriatic arthritis, characteristic findings are bone resorption of the tufts in both hands and feet leading to whittling or pencilling and eventual destruction of most of the phalanx. The nail of the involved digit is also affected in nearly every case, sometimes with subungual calcification. Similar resorption and osteosclerosis of the terminal phalangeal tufts may be seen in systemic lupus erythematosus, rheumatoid arthritis, Raynaud's disease, scleroderma, mixed connective tissue disease, frostbite, thermal and electrical burns, Lesch Nyhan syndrome, pachydermoperiostosis, multicentric reticulohistiocytosis, progeria and sarcoidosis. Tuftal sclerosis likewise can be a normal finding in some persons.

In hyperparathyroidism, submarginal localized resorption of trabeculae with small calcifications may be evident after haemodialysis. The calcific deposits in mixed connective tissue disease are often small and punctate.

A width of the phalangeal tuft of the third finger of 12 mm or greater in men or of 10 mm or greater in women is considered suggestive of acromegaly. Prominent tufts are well recognized in the hands and feet in this disease. The tufts tend to be larger in persons who perform heavy manual labour, however. Elderly persons may have irregular excrescences on the tuft.

DR