What causes the Hatchet sign in the humeral head on radiographs?
Let me know in the comments.
Click to reveal the answer
The Hatchet sign is caused by a circumscribed erosion or depression of the lateral-dorsal aspect of the humeral head. It is typically seen on radiographs in destructive joint diseases such as chronic arthritis, including rheumatoid arthritis and other inflammatory arthropathies. In these conditions, ongoing synovial inflammation and mechanical joint stress lead to focal bone resorption and erosion, resulting in the classic hatchet-shaped deformity of the articular surface.
Why is it called so?
It is called the “Hatchet sign” because the localized erosion creates a distinctive hatchet-shaped contour on the lateral-dorsal surface of the humeral head. This sharp angular defect resembles the blade of a hatchet or small axe, distinguishing it from other articular abnormalities.
Pathophysiology
Chronic synovitis and repetitive mechanical stress cause subchondral bone and articular cartilage destruction. As bone resorption progresses, a sharply demarcated defect develops at the lateral-dorsal aspect of the humeral head, altering the normally smooth curvature into the characteristic hatchet-like outline. This reflects advanced joint destruction compromising both anatomy and function.
Alternative names: none
Other associated named signs: None specifically associated, but it differs from findings such as avascular necrosis-related collapse patterns.
Improve Content And Help Your Colleagues!
Found an error in the post? Please let us know using our contact page and we will update it with due credits!
If you wish to contribute radiological images for this case (or any other article on the website), you can submit them here and you will be duly credited: Submit radiology case