Rare Conditions

The Short 4th Metacarpal

We will, from time to time, evaluate a patient presenting with a painless shortening of the 4th (and sometimes 5th) metacarpal.  Often, the complaint is of an absent knuckle or a different- appearing hand.  Here is one such 14 year old patient.  The primary issue is the shortening of the ring finger metacarpal bone although the pinky does look somewhat short also.

Patient presenting with a short 4th metacarpal.

Patient with a short 4th metacarpal– notice that she lacks a knuckle on the ring finger.

Side to side comparison of short 4th metacarpal patient affected on one side only.

Side to side comparison of short 4th metacarpal patient affected on one side only.

X-rays tell the whole story.  Notice how short the 4th metacarpal is compared to the other metacarpals.  There is no growth plate in the 4th metacarpal.

x-ray showing short 4th metacarpal.

Thankfully, in this patient and others like her, this is a painless problem and one that rarely causes a functional problem.  So, we recommended careful observation and if problems ever do occur, there are options for treatment.  The most reasonable option is to lengthen the 4th metacarpal bone- here is a previous blog post on the topic.  However, the challenge with this procedure is the balance of the tendons.  The patients muscles and tendons have grown accustomed to their current length and if we make the bone longer, the tendons do not always adjust well.  Yet another reason to not intervene unless pain or functional problems are noted.

Finally, we all wonder why this happens.  There are many possible causes.  This site summarizes the possible causes.  
– Trauma.  If the growth plate to the 4th metacarpal was injured when the patient was much younger, it might have shut down and simply not grown any further.  This patient, and most, do not recall such a trauma.
pseudohypoparathyroidism or pseudopseudohypoparathyroidism.  OMIM describes the second issue very well here.
Finally, here is an article on the topic.
Thanks for reading.
Charles A. Goldfarb, MD
My Bio at Washington University


  1. Thank you for the question. Most likely, this is a random event without a known genetic event. However, there are types that are genetically determined including some types of pseudohypoparathyroidism.

  2. My 11-year-old daughter has this in both hands and one foot. She is experiencing pain that radiates from her hand to her shoulder. Is this to be expected as she continues to grow?

  3. Beth,
    Pain is very unusual in this condition. The short metacarpal may not be the reason for her pain. Hopefully this will resolve on its own but an evaluation by an experience pediatric hand surgeon might make sense.

    Good luck.

  4. I was so glad to find this site – I also have this condition and look identical to the patient in the picture (my left hand ring finger is the finger affected). Thanks so much for putting this information out there – most of my primary physicians have not known much about it, and just say 'hmm' when they look at it, so I've always craved more information. Thank you!

  5. Hi, I'm happy to have found your blog. I have a short 4th metacarpal on my left hand and on both of my feet in the 4th position. I also have "clubbed thumbs" on both hands and a few bone anomalies in my mouth (bump on roof of mouth and two protruding bones behind my teeth on my lower jaw). Do you think these are all related and may point to any sort of syndrome? Thank you in advance.

  6. April, thank you for your question. While I do not immediately recognize a syndrome based on your description of the bony differences you shared, a syndrome is possible. Is there a family history of anything similar? If you visit the OMIM site and type in short 4th metacarpal, you will see some examples of the possible conditions.

  7. i have this on my right hand and find it very embarrassing to show my hand. i find incidences when i need to show my hand e.g. shaking hands very humiliating as people stare as if I'm a freak. would really like surgery to lengthen.

  8. Fatima,
    Thank you for the question. I am sorry you are so concerned about your hand appearance- each patient will have a different opinion on appearance. There are two problem with lengthening the metacarpal: 1) It creates a long scar on top of the hand 2) There is a risk of stiffness of the finger after lengthening.

    I hope that helps. Good luck.

  9. Hi I have the 4th knuckle missing on both hands which was only notice at the age of 12 , no pain or other symptoms , nevertheless I have sickle cells trait , could that be the cause ? Thanks

  10. Jeana,
    Thank you for the question. Your question is a good one. We believe that most cases of the short 4th metacarpal are present from birth but may not become apparent until the period of growth with adolescence. It is possible that sickle cell could play a role but I don't know of any evidence for that theory. It is more likely a genetic issue different from sickle cell trait.

    Thank you.

  11. What if all our metacarpals are short like that? I was a strength athlete in high school and just always thought my hands were small. They are becuase of this. Both the region in the palm and the fingers themselves are long but the metacarpals are short.

  12. Qassem,
    Thank you for the question. This is unusual. The metacarpals make up the palmar length so if the metacarpals are short, typically the palm will seem short also. I hope that makes sense. I do not know of another diagnosis when all the metacarpals are short with normal fingers (phalangeal bones).

  13. Is this something I can have fixed? I have normal function in my hands, it's just it is very ineffective for my strength training(past). I got very strong as a highschool student, but still, my hands always help me back. Especially with pulling movements.

  14. I'm a 46 year old woman who has same abnormality in both hands, 4th metacarpals. My second cousin has it in both feet, 4th metatarcels. My daughter was born with Achondroplasia. None of these things are linked genetically, per a genetic specialist. When I was in middle school, I had them corrected. This was done by Dr Richard Smith at Mass General in 1982 and 1983. I was a clarinet player and had difficulty reaching keys. Both metacarpals were lengthened with cadaver bones and each one secured by two different methods. I wore incredible contraptions to stretch the tendons in my fingers. The right hand had a pin in it, that was removed by pulling it out, not requiring additional surgery. The left one has a plate and screws. Both fingers function beautifully. The right hand doesn't look as good as left hand. But nobody notices the missing knuckle, except me. It's there but just very small in comparison to the left.

  15. I have this same abnormality on my right hand (pinky). My brother has this in on both pinkies. It's so embarrassing. Will I be able to tell if my daughters have this? Or is this something I have to wait until they start growing? I have looked on both of their hands and haven't noticed a "missing knuckle"

  16. Great article! I have the same issue on both hands 4th metacarpal AND both feet in the same area. Both toes next to the pinky toe. I had my toes lengthened though. Any idea why/how both my hands and feet got this abnormality?

  17. littlemissnotsoperfect,
    Thank you for the comment and question. There is likely a genetic component to this condition (even if no one in your family has this). Interesting that your toes were lengthened- that is an uncommon surgery.

  18. I'm happy that I found this article. I also have a short 4th bone, and have seen a hand specialist once at the age of 12 in Philadelphia. I broke my hand as a child and now at the age of 23 it is causing me severe pain. Especially in the winter.. Wondering if there is a cure for this..

  19. Thank you Joanne. Short metacarpals are rarely painful and, therefore, we rarely consider intervention. However, if severely painful without other identifiable causes, lengthening of the bone could be considered. Not a cure but could be helpful. However, lengthening is not straightforward and will not be the best choice for most. Good luck.

  20. Hello, I'm 21 and I have this on both ring fingers. I know the surgery isn't recommended, but do you think the extra skin built up can be removed? I am self conscious about the appearance and am getting engaged soon! I don't want to bring attention to my finger with a ring.
    Also, thank you for writing this article! I never knew what my condition was called or if others had it too! 🙂

  21. Hello and thank you. I am not familiar with 'extra skin' associated with this diagnosis. However, if that is the problem, there may be surgery which can help. Find a hand surgeon near you with experience in treating birth conditions of the hand and arm. Good luck!

  22. Thanks for this blog. My daughter has a shortened 4th metacarpal on both hands and feet. She is 11 but I am concerned that as she grows the shorter fingers will give her problems. Will they grow still? Also since it is consistent on both hand and feet is it more likely connected to a syndrome? Should I be looking for other possible symptoms.

  23. Kim,
    Thank you for your question. As mentioned, the short 4th metacarpal can be associated with several conditions including pseudohypoparathyroidism (or variants) or various syndromes (as well as trauma or infection although these are less likely given that both hands and feet are involved). I would suggest a discussion with your pediatrician and possible endocrine workup. Good luck.

  24. Hi I'm 17 years old and also have this on both ring fingers. They are fully functional and no pain but I am embarrassed and uncomfortable, especially when people realize. I really want to get surgery to fix it. Is it possible and safe? Will the knuckles grow into place once the finger is extended?

  25. Jimmy, thanks for your question. While surgery is possible, in general, I don't encourage it for people who are functional and have no pain. Your hand will be scarred from the surgery and will still not appear 'normal'. I hope that makes sense and helps. Discussing this with a hand surgeon who treats kids will be helpful for you.

  26. Hi, I'm 16 Years old and i have a missing knuckle on my ring finger. All my fingers are normal sized and none of them bother me. Both of my parents have knuckles that are present. I have a younger sibling that also has a missing knuckle in the same area. What is the cause of this?

  27. Hello Josselyn,

    You may have a short metacarpal. There are numerous reasons but given your sibling's similar situation, a genetic cause is likely. One option is to search on OMIM.org- just type in short 4th metacarpal.

  28. Hi! My mother had the issue just on one of her hands, one ring finger, as well as one foot on the 4th toe.
    However, I have the hand issue with both ring fingers, as well as my left middle finger.
    My identical twin has the same situation with her hands, but both of her fourth toes have the issue too.
    There seems to be something genetic about it. Why do you think we are missing more than my mom? And why are my toes normal when my sister's arent??? We are both 22 and it has been bothering us for a while

  29. I have 4th metacarpal short on my foot, my mother's 5th metacarple on her hand is short/no knuckle with fist (she is only one of 5 siblings with this,her parents don't have it), my first cousin on mom's side has short 4th metacarpal on his hand and my 7 year old son is now showing signs of no knuckle on the 4th metacarpal. None of us have pain or other issues except my mother and I are 4'11" and 5'1" and my son is only 45 inches, wonder if age 7.5 is young enough to get his 4th metacarpal bone growth stimulated with treatment of some kind.

  30. Aakatiezz,
    Thank you for sharing your experience. This does sound like an inherited condition- sometimes the website-www.omim.org can be helpful in sorting this out. A geneticist would be helpful and a pediatric endocrinologist might be helpful as well. Finally, I am not convinced that a congenital hand surgeon will recommend surgery, it would certainly be a good place to seek advice.
    Good luck.

  31. Yasemin. I assume that you are the only member of your family with the short metacarpal. If so, then it is uncertain if you children will share this hand difference. Sorry I cannot be more definitive.

  32. My 13 yr old daughter has the 4th metacarpal on her left hand. She was about 9 or 10 when we noticed it. As she has gotten older she has lost the strength in her hand and experiences pain, she has problems holding some things and has difficulty opening bottles and similar things. Is there anything that can be done to help.

  33. Toni,
    Thank you for the question and I am sorry you daughter is having pain and decreased strength. On occasion, there may be therapy which can help (and this is always a good first step) and on rare occasion, surgery to lengthen the metacarpal might make sense. I hope this is helpful.

  34. I'm a 40-year-old female, and I have a shortened 4th metacarpal and shortened 4th metatarsal, both on the left side, discovered when I was around 10. My first son was born with bilateral polydactyly, with the "accessory digits" attached on the sides of his pinky fingers. I've always wondered if my condition and my son's could be related. Do you know of any research linking the two?
    Kindest Regards,
    Kim Lane

  35. Kim,
    Thank you for the question. I certainly have seen various situations in which a parent and child have different hand anomalies although polydactyly and shortened metacarpal/ metatarsal are tough to connect. I do not know of pertinent research- sorry.

  36. My wife has fourth knuckle missing and it doesnt hurt her or do anything. Her fingure can move absolutely fine. No one in her family has got this disorder and she is the only one. Can this issue be passed on to my kids or its a one off disorder? Please advise. Thanks

  37. John,

    Thank you for the question. I am glad your wife is doing well. That is the experience of most people with a short metacarpal. It is unlikely to be passed on but there is a small chance that this is genetic. I hope this helps.

  38. I play the piano and I wouldn't want to ever stop. I have 2 missing knuckles on my left hand and that sometimes causes minor pain whenever I play. Is it possible I can get surgery to lengthen then and help me with my performance? Im 16 and im glad I'm not the only one that has this….

  39. Thanks Eva. I am glad you are playing the piano and shouldn't stop. I don't think the missing knuckles will limit you aside from, as you describe, occasional mild pain. Surgery to lengthen the knuckles rarely makes sense but could be an option in patients with pain which limits function. I hope that makes sense.

  40. My daughter has had this on both rings fingers. We just noticed it about a year ago. They are now sending us to a endocrinology clinic cause she is now 13 and has high hormone levels for 2 years. She still hasn't started her period yet. They are pointing more to hormones maybe the reason why. Has anyone else heard of this? Also her pediatrician said it could be caused from scarlatina. My child never had scarlet fever so this was odd to hear. I'm looking for answers for this cause I heard it can cause her organs to possibly not grow either on the inside. So I'm freaking out.
    One worried mother

  41. I am 42 and have on both hands missing 4th..my sister has missing 4tu and 5th as well as my mom its absolutely hereditary and i play guitar and never have had any dexterity issues.
    But this is absolutely passed in my family

  42. Hello, My mother has short 4th Metacarpals on both hands and i have a short 4th metacarpal on my right hand and a short 5th metacarpal on my letf… We are the only people in our family with short Metacarpals… Could it be possible that my mother has started a genetic trait that will carry on to further generation?

  43. Catelyn,
    Thank you for the question. It is possible that there is a genetic trait that may be passed on. It is also possible that your mother's mom or dad may have had a milder deformity. There are no easy diagnostic tests to my knowledge at this point.

  44. I have this in all fourth fingers and toes (although left foot is hard to discern). I am 58 years old and have experienced many broken fingers playing ball games, but they have never caused me any pain. To be honest, the biggest issues are shoes (sandals), carrying bags (straps cut in) and wearing jewelry. I also find the excessive tissue on my hands a little unsightly (my issue really). I have toyed many times with corrective surgery, but they all work and the outcome of surgery might be less effective hands. It's nice to think this may be an aberration as none of my children have it and I was concerned about passing it on.

  45. I have this it is associated to Turner syndrome doctors have told me that there is nothing they can do but I want to know your opinion.

  46. Lili lil,
    Thank you for your question. A short fourth metacarpal bone in the hand is associated with Turner Syndrome. We usually recommend watching this as it is not painful. The bone can be lengthened but the surgical scars are usually pretty prominent. I hope this helps.

  47. Hi, I am a 28 old female with short 3rd and 4th metacarpal bone in my left hand and a 4th one in my right hand. Somehow I could ignore the fact that it may be genetically passed through generations until this day but now I kinda feel that it is in fact very likely to be genetic (now I started to think about my mom's different 4th fingers in her both feet). Looking at my sisters and my other cousins normal fingers and bones I assume that it is not severe anyhow in my family but I can't help but asking if I'll have a child how would it be?

    Anyways, I was searching about the reasons behind it and I found out about Turner Syndrome. Can I learn if I am missing a chromosome by asking for a chromosome analysis or something like that? Because by looking at that syndrome I might not even have a child 🙂

    Am I getting paranoid or all the maternal diseases that we got in our close family (like hashimoto thyroiditis of my aunt and her child and bone malformation in my own family) can be related with the same genes?

    Lots of questions in my mind… But I want to state that besides its physical effects it has a huge impact on personal development and psychology. I am now fine but I wasn't very self-confident when I was younger. I hope there are good research papers on this side of this anomaly.

    After all thanks for this blog, it enlightened me 🙂

  48. Mel,
    Thank you for the comments and question. You should seek out a geneticist for advice on conditions and potential testing. The genetics doctor will be a good source of information about yourself and potential children. It is doubtful that other familial diseases are related to the short metacarpal. Good luck.

  49. i just found this cite.Im from Nairobi Kenya and i have never seen someone with missing 4th finger knucles untill i saw this thread.im glad im not the only one with this condition.My fourth 4th toes also dont have the knuckles and are shorter than normal.my only problem is showing people my “interesting embarassment”as both hands and toes function properly.They are neighter painful nor causes hand and toes discomforts.I have learnt to embrase my missing knucles fingers and toes.For those looking for away to correct them , Wishing you all the best.Thank you so much for this article.

  50. I am a 46 year old woman. I have this problem in my right hand, (finger next to pinky) never caused me any problems, but sure does look funny and creates a lot of conversations,and laughter. 😁

  51. Dear doctor, my daughter is 9 month old. Recently, When I touch her hand, I feel a bump on the fourth finger joint and when she make a fist, I can feel the knuckle is sink a bit. As she is so young, is there a way to “fix” it? We adore her so much. Thank you!

  52. Melissa,
    Thank you for the question. It is difficult to help without knowing more. I would recommend that you see a pediatric orthopedic surgeon or a hand surgeon (or, if available, someone like me who specializes in kids' hands). Xrays and an examination will help understand what exactly is going on with her hand and lead to the best advice. Sorry I could not be of more help!

  53. Melissa im missing 3 knuckles they are there just pushed back towards wrist..stop worrying be happy you have a healthy daughter..im 42 now and i play guitar and do jiujitsu..my hand writing is not as nice due to the way my hand curls but nobody writes anymore anyway..lol…there is nothing to fix on your daughter go give her a hug 😉

  54. Thanks doctor for your reply! I took her to see an paediatric orthopedist. By observing and touching her hand, he said it is a ganglion and doesn’t need any treatment if it isn't bothering the baby. We are quiet released. Thanks very much for your suggestion!

  55. Hi, I have a shortened 5th metacarpal on my left hand, and only recently noticed. While it has not caused any pain, I have come to realize that when I make a fist, the finger has very limited movement, only to bend forward and straighten out, while the 5th finger on my right hand can move in circles without issue. Is this normal considering I am missing an entire knuckle? Thank you.

  56. Thanks for question. This is a bit hard to answer but yes, there can be associated decreased motion with a short metacarpal. But your experience of no pain is important for other readers. That has been experience in taking care of patients like you.

  57. I have short 4th finger syndrome. But l have pain on 3rd finger. Doctor said its because of short 4th finger and he offer surgery. Is it possible to have pain for another fingers because of short 4th finger syndrome?

  58. While I have not seen significant pain in the next digits, it is possible based the tendon connections and inter- relations of the fingers. BUT, I do agree that this is not especially common. I am also not sure what surgery was offered…

  59. I wish I could offer my experience in this situation. I just have never had a patient in this situation and I have not lengthened a short metacarpal with the expectation of pain being improved in another finger. Another opinion might make sense.

  60. Hi Doc I'm a 30 years old female. noticed I have no right 4th finger knuckle when i was 11. Recently I feel pain and numbness on my index and middle fingers, otherwise I'm okay. No similar thing among my families excpet type 2 DM and recently my elder sister diagnosed with Hypothyroidism. I've nver seen a doctor before. Nver been bothered before hut now I'm getting curious
    I'm glad there's this chatting platform

  61. Hello. Thank you for writing. I am not certain your current symptoms of pain and numbness are related to the short fourth metacarpal. First, there may be other things going on in your hand aside from the short metacarpal. And second, there may be something else going on. An evaluation by an experienced hand surgeon will be helpful. Good luck.

  62. Hi!
    I have this on both hands, the short 4th metacarpal and knuckle set back/looks like it's missing. I was told growing up it wasn't a big deal and shouldn't be an issue/cause pain. I am noticing as i age though, that it is getting increasingly painful in my right hand. I do a lot with that hand – I am an artist and always working with it. It causes pain in that hand, and I am also unable to move that finger without using my 3rd finger as well, it won't move independently. I feel like it throws off the way my hand moves and functions. Is there anything I can do about this? I am now 28 years old. Thanks.

  63. Thank you for sharing your experience. Pain is not common, at least in the patients that I have seen. I would definitely recommend an evaluation by a hand surgeon, ideally one who has experience with kids and adults. Good luck.

  64. Oh my God I am so happy to come across this today.I have the same problem on both hand I have 2 short knuckle and 2 short finger just like the pictures. I have never realized it until I was 11 years old .I always wanted to be a Fashion model but because of my finger that Destroyed my dreams . sometimes I do feel some type of discomfort but It's all depends on what I'm doing . Now I have become a mother the day I gave birth looked at my daughter's finger everything was OK ..6 years later a family member looked at her fingers in realize that she has a short knuckle But only on her right hand …Surgery is definitely an option because I do not want her to go through what I went through ….How do I find a doctor that is specialized it fixing it….I live in New Jersey and I've been looking please help

  65. I have this in both hands and feet. Im 23 and its been my entire life. Is there any option for adults to get it fixed? I want it fixed for my wedding someday. My mom and i were also wondering how rare it is that its all four fourth digits.

    Im so happy i found this. Its been one of my biggest things since i was little.

  66. I lack a knuckle in both my ring fingers. And it's so embarrassing honestly. I would rather go with having the surgery and dealing with the pain. I wish my hands were just normal. It bugs when people stare at them to. I would honestly wanna know how much the surgery is to lengthen both ring fingers..

  67. My sister has both hands shorter 4th and 5th. My other sister doesn’t have this but her daughter does. Same 4th and 5th in both hands. Our mother has a shorter 4th and 5th toes in both feet. My daughter is pretty much missing all of her knuckles. Never noticed until she turned 10!!

  68. Sid, thank you for the comment. It seems as though this is clearly genetic in your family (vs. related to an endocrine abnormality or a random event). OMIM.org is a wonderful site to work through this presentation if it is of interest.

  69. My 9 years old daughter has no knuckles and short metacarpals on both her ring fingers. No issues observed other than cosmetic. No one in my family or my husband's family have this issue. Uneventful pregnancy, unclear to me what is causing this. Kids at her school have noticed the absence of knuckles and short fingers and some have made fun of her. Not sure what to do.

  70. Thank you for writing. This is a typical situation without family history and without functional issue. The deformity may gets worse as your daughter continues to grow. I would provide support for your daughter regarding kids at school and emphasis that this makes her different but does not limit her. Talk about it as she is willing. Surgery can be done to lengthen the short bones but it has risks and certainly creates scarring. Surgery can be considered but it is not my first choice in this type of situation. I hope this helps.

  71. Thank you so much for your answer. Do you know is this type of surgery is done in Canada? If so, could you please share with me the name of a hospital or surgeon so I can explore the options?
    Thank you.

  72. This genetic abnormality runs in my family. I have a short 4th metacarpal on both hands and one foot. I have a sister with short 4th metacarpal on one hand and a sister with it on one foot. My father was missing knuckles on his 3rd, 4th and 5th on both hands and 4th on both feet. We come from a big family on my father's side and all his siblings and their children have some form of this genetic abnormality. During family reunions everybody compares their hands and feet and laugh. It has caused no functional probles with anyone that I am aware of. The trait seems to be disappearing with our children and thier children.

  73. I have lived 44years with missing 4th metacarpals and I play guitar and powerlift..it does not interfere with life other than you will get a callous
    Further down your palm since the knuckle is just set back.
    My whole mother's side has this trait and my sister.
    They were from Germany and Czech republic and 1st generation in this country (USA)…I wonder what
    nationalities everyone else is..anyone else German and slovak origin?
    My sister and I are generation X.
    How about you all?

  74. Dr. Goldfarb, I don't know if this sounds stupid but when I was younger, 10-12-years old, I had a habit of stretching/cracking all my fingers except for the 4th fingers (both hands). Could this have caused a trauma to my fingers and it caused them to stop growing? Whenever you're reading this, thank you, have a nice day and stay safe!

  75. Federica,
    Thank you for the question. I believe that no question is 'stupid'. BUT, you did not cause this and could not have prevented this from happening., There is a genetic piece to this. Good luck and you stay safe also!

  76. Oh my god..I feel so relief after reading this blog and comments..I used to feel like,it was just me but why me.Sometimes this shit hits me with bad trauma,I too want beautiful fingers and nails like other girls.
    Anyway, sometimes I feel different and it's just ok😊

  77. Wow! It is nice to know that I am not alone! I have a shortened 4th metacarpal and shortened 4th metatarsal, both on the left side, plus a shorter, fatter thumb on the left hand. My mother has the one shorter thumb and her mother had two shorter thumbs but I'm the only one with the shorter finger and toe. I also was born with a cleft lip and my nostrils are different sizes. As a child, I found this all embarrassing but as an adult, I make a point to show people my differences. I would rather tell people than have them wonder about it. I certainly embrace my differences and feel that it gives me a little bit of an advantage with my work. I work with people who have Autism and other developmental disabilities and I feel that my differences help me to be more understanding of their differences. We are "different, not less."

  78. I have this condition on my right hand the fingers affected is the one between the middle and pinky ring finger I had it for as long as could remember i am 50 years old now never hurts or gave me any problems it just look different because it is shorter and missing a knuckle my left foot my third toe is shorter and is also missing the knuckle had it for as long as I can remember never hurts or gave me any problems I guess it's normal for me I am happy to have found this page and to read all the post and I am not the only one with this condition I was very curious about my toe and finger all my life never met another person with this condition now I know a little about it thank for sharing

  79. I have short metacarpals on my left little finger and my right 4th finger. I noticed when I was 9 and it became more apparent as I grew.
    If you have this, don't be embarrassed! 'Normal' hands are boring. I quite like how my knuckles look and feel weird. I can play piano, cello and bass guitar, and I have no problems with grip when I do things like rowing or rock-climbing.

    The only time it ever annoys me is when playing notes with the little finger on bass guitar, because I think it makes it a bit more awkward to reach and hold the thick strings down strongly enough. Practising with just this finger will probably help though 🙂
    I am female, is it more common in women?

    1. Hi I have exactly the same conditions as yours..I found it when I was 9 year old. As I was a child I didnt think about it, but when I was teenager I got really embarrassed and it had been driving me crazy every time I was at school and had to writing infront of my friends. I was extremely upset because I didnt know why and how it happened to me. But now as I am 22 I dont think about it (well maybe sometimes still, but not upset anymore). I am happy that I found this article and knew that I not the only one who have this situation.

    2. I have the same issue, and when I was young I was embarrassed, then the older I got I was use to it and accepted how I look. I get annoyed when people look at my hands, then theirs instead of just asking .

  80. Thank you for sharing your experience! While the short metacarpals are very rare, they can be associated with even more rare syndromes. They are, at least in my experience, more common in women but I am unable to provide exact %.

    1. I am a 22 year and have a short 4th and 5th metacarpal on my right hand and have had so since I was little… it is quiet embarrassing as I have smaller hands and a really little pinky compared to all my male friends… I wish there was a way to almost get rid of it… my father does not have it but my mother does… so I’m assuming it is hereditary and I hope my daughter does not inherit this gene.

      1. Danny,
        Thank you for writing/ sharing. If your hand function and strength are good, it might be best to live with it. The other option is to lengthen the bones but there are risks with that procedure. Good luck.

      1. Michelle,

        Thank you for writing. Beals syndrome patients do have bent fingers (and other joints) and an inability to straighten those fingers and joints fully. However, the bones are not specifically affected and the metacarpals are typically of normal length.

        1. Hi I have a short 4th metacarpal on my left hand and that’s coz I got bashed years ago and years later had to have surgery to fix it but it’s still not fixed as my knuckle still isn’t there and I still get pain with it but worse now, can they put my knuckle back in place?

          1. Sometimes the short metacarpal is related to an endocrine or genetic issue and sometimes it can be related to a growth plate issue from trauma. The treatment, if any is indicated, is related to pain. Typically we would consider lengthening the metacarpal as long as the length seems to be the issue.

  81. I am 25 yr old and I have this condition on my both the hands, both the metatarsals of 4 and 5 finger are short..being a dentist at times it hurts to hold forceps for a longer time span or it hurts when I have to apply the pressure…and it's very difficult for me to strum the guitar too… could you suggest something would be great…

  82. Thank you for the question. While it is difficult to give 'blind' advice, therapy might be a good place to start to strengthen the intrinsic muscles of the hand. I doubt there is a surgery that would help. Seeing a hand surgeon with experience in this area would be the best next step. Feel free to email me directly if help: congenitalhand@wustl.edu

  83. Hi i have this in my both hands and feet. I have extra fat on both hand fingers which makes it obvious. Just like this patient's finger. Would you recommend a small procedure to cut the extra fat on 4th finger. Since the bone lengthening is risky i don't wan't to take that risk with my hand.
    p.s. Thank You for this Blog 🙂

  84. I have the wide thumbs on both my hands.. my 4th finger on both hands are very short but I do have both knuckles but they sit far back.. I would like to learn more about this. I am 37 and healthy and I havent seen anyone genetically in my family with this.. I did learn I had an unknown maternal grandfather and so I just dont know… I wanna learn more.

  85. Hello my daughter (8) has short metacarpals on 2345 on left hand and 345 on right hand, so basically only her right index finger metacarpal is normal and outgrowing the rest. Are you aware of any procedure that can shorten or slow the growth of the normal metacarpal?

  86. Raffi- thank you for the question. That is an unusual presentation of short fingers. However, your question is a good one. Yes- we can slow down growth of individual bones. It will be important to see a pediatric hand surgeon who can calculate growth remaining and determine the best time to stop bone growth. This can be a highly effective surgery. Good luck.

  87. Dr. Goldfarb,

    I am a 28 year old healthy male with bilateral short 4th mets. My mother and sister also has short 4th mets. My labs are all normal. My wife is also healthy and has bilateral short 4th and 5th mets with normal labs. She was recently screened for the GNAS gene, which was normal.

    We are concerned about passing down this defect (or associated defects such as mental impairments.) I was wondering if you've seen this in your experience and what your recommendation might be.


  88. Thank you for writing. You are correct- in all likelihood, there is a genetic predisposition to your short 4th metacarpals. If you search at OMIM.org, there are lots of potential genetic conditions (obviously the vast majority do not apply). The GNAS gene is a thought. The other possibility is an endocrine abnormality but less likely given how common in the family. Good luck. A geneticist might help.

  89. Hello Dr Goldfarb,

    I am a 28 year old woman , I also have a short 4th metacarpal , I’m missing my ring finger knuckle, I lived with this all my life with no pain, but recently I started getting shooting pains from the affected finger up to my elbow , I wanted to know what could possibly cause this

  90. Hello Melissa,
    Thank you for the question. Typically, the short fourth metacarpal does not cause pains as you describe. There are other possible causes of radiating pain including nerve issues. I would check in with a hand surgeon for an assessment. Good luck.

  91. Hello I just stumbled across this article while trying to learn a little bit more about this. I have this on both hands, as well as my mother, brother, uncle, and past grandfather.

  92. I am 76 years old and have this on both hands. I found out nobody ever noticed it unless I told and showed them. Never any problems.

  93. I'm 78 and was just given the name of this. I have the short metacarpal only on my 4th finger on my left hand and felt self-conscious when I was a teen and young adult, especially wearing wedding rings (Rings do emphasize the extra "fleshiness" of that finger). But I learned most people don't even notice it. I've never met anyone else with it, but never had any pain or problem other than a little more difficulty/stretch playing the piano and viola. None of our 4 children have it and so far it hasn't shown in our 12 grandchildren. The only possible associated endocrine condition in the family which I share is hypothyroidism.

  94. Hello, I came across this article recently after looking into possible reasons for my 8 yr old daughter's 4th finger being shortened and thinner towards the tip on one of her hands. Her fingernails also seem to show some abnormalities by appearing round and shortened on both of her hands. As she has gotten older the size of her ring finger has definitely become more pronounced on the one hand, and is showing a noticeable difference in size. When she was younger her doctors thought that her hands were showing some abnormal characteristics possibly associated with the same unknown condition as her feet, but were unsure and xrays didn't show anything abnormal in her hands. Although, it has been a few years since xrays we're taken of her hands. She does have a congenital condition that affects her feet, where she is missing several toenails, and has missing or underdeveloped distal and middle phalenges. Most of her toes are affected to some degree, but some more then others, especially the middle and big toes. We have seen geneticists, and she is a patient at Shiners Children's Hospital in Portland, Or. She has had genetic testing and mapping of her genes with certain genes identified but with unknown significants. The syndromes associated with the genes do not fit her clinical presentation, nor does she fit known syndromes that affect the digits. I'm wondering what syndromes or conditions come to your mind that I could possibly shared with her doctors? Thanks

  95. Thank you for writing. This does not seem to be a simple short metacarpal but rather more similar to symbrachydactyly (although symbrachydactyly usually only affects one extremity). A Shriners Hospital is typically a great place for diagnosis in uncommon conditions but not sure if such a diagnosis has been provided. A genetic diagnosis is great when it can be provided but honestly, this is not commonly possible. An experienced clinician (i.e., busy hand surgeon) will have a good perspective. Good luck.

  96. My 4th and 5th on both hands have been like this for as long as I can remember (33 now), but not as drastically shorter like the pictures above. It's interesting to put a name/reasoning to it! I guess I'm just missing 4 growth plates! Thankfully I've also have never experienced pain, and I've always just told people I have "baby knuckles" lol
    Have never met someone else with the same look to their hands! Thanks for writing this!

  97. This is half a decade late, but I have the exact thing on my left hand. It is a common association with Turner’s Syndrome. I don’t know the etiology behind it but that is what I was told

  98. I also have the same problem with fourth finger in both my hands and feet.I have never seen people with this problem like me and find its very embracing but now I m glad to find this article and people like me:).love from India❤️

  99. I am also and artist and have this in both hands. As well as short forth, I have short fifth on my right hand. This causes me pain as well since I use my hands a lot. I have been to a hand surgeon and he told me there really wasn't much that could be done. He did, however, recommend I wear a brace when it causes me pain. I attended physical therapy for a short period of time but found that it wasn't that helpful. To help with the pain, I just wear a brace when pain flairs up or I wear compression gloves if it is persistent.

    I hope this helps. From one artist to another.

  100. My 33 yr old daughter has shortened 4th metacarpals in both hands, as she has aged, occasionally her hands hurt. When she was about 6 or 7 she came home, clenched both hands and said, look mum!! I was horrified, thinking she was missing both her knuckles, I whizzed her up to the doctors, who referred me to a genetic doctor, upon going through all the known syndroms, she did not fit the rest of the criteria, she was exceptionally tall and skinny, for one.
    On two occasions, years apart, we looked into having the operation to correct the metacarpals but the risk of over stretching the tendons, which would cause her finger to sit in an un natural position, out weighed the benifits. As far as I know, she is the only one in the family with this condition, her younger sister's hands are normal. Both daughters were diagnosed with ADD and the older with dyscalculia, so not necessarily mentally retarded, as with some of the known syndroms.

    Recently, I read an article about peoples abnormalities, there was a picture of someone with the shortened 4th metacarpal, in this section, they said that people with this, have hypermobility. Which has lead me to this article, I have never associated her flexability to the shortened 4th metacarpals. My daughter has hypermobility but does not fit the rest of the criteria of the syndrome that states these people have hypermobility.

    Have you heard of other people or know of people, who have the shortened metacarpals and hypermobility?

    1. I have this in my right pinky finger. I always thought I was just born without a knuckle. I also have lipedema which has hyper mobility as one of its many symptoms. So this just became very interesting. Thank you for this article.

  101. I have a missing knuckle on my right ring finger. It does not cause me issues but my right hand is a little weaker then my left. I do not know how it happened or if I was born with it. I do not know if this has a name or anything. The doctors do not know how I got it nor do my parents. My right ring finger is shorter than the one on my left and when people see it they freak out. Do you know what this is or if it will cause me any issues? Or anything with genetics?

    1. Morgan,

      Thank you for writing. This could very well be genetic (ie, something you were born with) or you could have injured the growth plate in the metacarpal (less likely). Please see links on the page for addition resources. Good luck.

  102. My 12 year old son has no knuckles on the ring finger on both hands. He is very self conscious about it. I am wondering if you recommend any procedure to correct this issue.

    1. Hello and thank you for the question. While difficult to know without X-rays, it may be that a short 4th metacarpal is responsible. There is an option to lengthen the metacarpal as noted in my posts. However, the decision to lengthen the metacarpal is complex and a good discussion with a congenital hand surgeon is recommended. This surgery can be successful but there are also complications with surgery that need to be understood. I hope this helps.

  103. I, too, have a missing left ring finger knuckle. My older sister is missing her right fifth knuckle and younger sister is missing her 4th & 5th knuckles on both hands. Mine is exactly as my Dad’s (missing left ring finger knuckle) and his mother was missing the ring finger knuckle on both hands. I showed this to one of my teachers in school when studying genetics and she said it was a sex-linked genetic trait.

    1. Vicky- thank you for sharing. There are a number of genetic transmission pathways but I would never disagree with your genetics teacher!

  104. I have this on both my ring fingers, I’m in my early teens now and I really appreciate people talking about this. I am still insecure about it and sometimes even check to see if it’s noticeable on photos before posting but these comments are genuinely so amazing. I made the mistake of showing it to my friends but they sometimes tease me about it or show other people in my class, then they ask to see my knuckles all the time which makes me more insecure! My finger length isn’t 100% noticeable yet but I worry that my pinky will grow longer than my ring finger and I’ll feel even worse. (I struggle with mental health and self-confidence)

    Just wanted to thank everyone who commented for being so open and truthful about how cool this condition can be! Thank you all xx

    1. Robyn,

      Thank you for your post. The good news is that given your age (early teens) it is unlikely the metacarpal growth will make this more noticeable.

    2. Robyn, my little “gimpy finger” is one of my very favorite things about me. She’s just her own cute, special little self. I can understand that it could make a person self conscious but I hope that you will be able to see that this little difference is something to treasure. I’m 49 and have only met one other person with this same characteristic so I figure this makes me one in a million. In all those years only a few people (like 3 or 4…seriously) have ever noticed this on their own and I take the opportunity to compliment them on how observant they are. No one else on either side of my family has it and unfortunately neither of my daughters do either so I get to keep being unique. High school sucks so I understand that you don’t necessarily want to stand out or be different, but wouldn’t the world be a boring place if we were all the same? I hope that you grow to love ALL of the wonderful unique things that make you who you are. Warmly, Sherry Ann

  105. I’m a 62 year old female and noticed my ring finger was shorter and missing a knuckle when I was around 9. I just got my hand x-rayed for another reason and asked the doctor about this and he said that I was born with it. But I remember a pretty brutal game of knuckles when I was around eight or nine and always thought that that game contributed to it. Could it have been this trauma? Or is it more likely that I was born with it?

    1. Debbie- thanks for writing. I do agree with your doctor- this most likely something that your were born with. If you have kids, it might be interesting to know if they have this?

  106. Hi. I hope you’re still available to answer comments. I most likely have the genetic component of this abnormality. Both my 4th metatarsals and metacarpals are affected. I had the lengthening surgery on my toes though when I was 16. I recently had two daughters. They’re young now so it’s hard to tell but will either one inherit this? No one else in my family has it.

    1. Nina,
      Thank you for the question. Unfortunately, there is no clear answer as, if this is genetic, there are different inheritance patterns. OMIM.org is a great website but only one condition, in my search, fits your description but has many associated conditions.

  107. Hi, I am 30 Yr old and me and my mom both have this condition of short 4th metacarpal and missing knuckle ( both hands) . In my case it was hereditary. We have never encountered any problems because of it except yes ,
    strumming of guitar. I would never change my hands, I like that it makes me unique. Besides people rarely notice it, unless I show it to them. Sometimes I do the spock sign to tell people I am an alien, just my way of having fun with it. But on a serious note it doesn’t hamper in any way and it’s painless so I never had any complains.

  108. My daughter has shortened 4th metcarpal on both hands and is quite short stature at 16. We have been independently researching causes and symptoms to identify if there could be additional issues. My uncle and cousins on my fathers side have marfan syndrome, I have found some cases online of people having both marfan and turner syndrome but could the likelihood of my daughter having turner syndrome be increased by the fact that marfan runs in our family?

    1. Ej,
      Thank you for the question. First, a geneticist may be helpful for your family. A geneticist can look for other differences and potentially perform testing. There has been some association between Turners syndrome and Marfans but its a stretch, in my mind at least, to make this connection in your daughter. As you have probably seen, most commonly, short 4th metacarpal is isolated or idiopathic. Your daughter’s short stature does increase the likelihood of a syndrome or association of findings. Good luck.

  109. The photographs are my hands exactly. It’s weird for me to see my hands that aren’t my hands. I’m so delighted to find this page!

  110. I have a short left 5th metacarpal which results in a shorter left 5th digit. I also work in medical and have a hard time wearing gloves. Has anyone with this discovered a trick for gloves to fit better?

  111. My twin sons both have this condition. Left and right hand no knuckle on ring finger. The ring finger is shorter than it should be. Also both feet are effected. No knuckle on the next to last toe and that toe is shorter than the last toe.

  112. I have a short ring and pinky finger on both hands but no one else in my family does and I did not pass this down to my son either. My arms are also too short for my body, not so short it’s noticeable at a glance but not in relative proportion. What childhood injuries could cause growth to stop if its not pseudohypoparathyroidism or pseudopseudohypoparathyroidism? How does one even get diagnosed?

    1. Thank you for writing. A few different types of doctors might help. A congenital hand surgeon, an endocrinologist, or a geneticist all may be helpful. Good luck.

  113. I have this on both hands and it’s so good to hear others have it too. I’m 31 now and still cover my hands with my sleeves. I hate the look but I understand the surgery is too risky. I found it uncomfortable writing my essays at school but have not come across any other issues.

  114. My 11 year old daughter has shortened 3rd and 5th metacarples on both hands which are becoming more noticeable with age. She also has hyper mobility and chronic constipation (unsure if these are related at all). Everything I’ve read seems to relate to shortened 4th and 5th- not the 3rd. I can’t seen to find anything that fits or
    Is similar to what she has

    1. Viki,

      Thank you for your comment. I agree, I am not aware of a syndrome or association with short 3rd and 5th metacarpals. I really like this site: https://www.omim.org – I searched there- you might want to also.

  115. I have this on both hands! Ring fingers are short and no knuckle. I’m 30 years old and just now reading about other people having this too! My ring fingers are VERY weak and I’ve always felt like they could break easily. Does anyone else have that? I tried to learn to play the guitar but my ring finger is not strong enough.

    1. Thanks Bobbi. I have heard patients note some weakness but yours sounds a bit more severe than others. Thank you for sharing your experience.

  116. I’m a 55 year young female. I decided to lookup info concerning my ring finger on both hands. I noticed it when I was a child. I too was embarrassed because the other kids would notice and ask to see and also show it to others as if it was on display. The only problem that I noticed was trying to type on the old fashioned typewriters. The keys were difficult to press because of my short fingers that felt weak compared to the other fingers. I didn’t realize that there was so many others with this condition.

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