Short metacarpal - third, fourth, and/or fifth
Page most recently updated 7 September 2026
This page focuses on short metacarpal (third, fourth, and/or fifth) as a morphologic feature of conditions that may also be associated with psychiatric manifestations, such as psychosis, mania, autism spectrum disorder, ADHD, OCD, and self-injurious behaviours. The page begins with a clinical definition of short metacarpal based on the standardized Elements of Morphology terminology, together with visual examples from the same source. This is followed by a list of conditions in which short metacarpal (third, fourth, and/or fifth) has been described in association with psychiatric manifestations.
Of note, to optimize clinical utility, the list does not include conditions associated with intellectual disability in the absence of other psychiatric features.
Each condition listed below is linked to a dedicated page within this resource. These pages describe the psychiatric manifestations associated with each condition, as well as other morphologic and broader clinical features, allowing the differential diagnosis to be considered from multiple perspectives.
Short metacarpals
This patient has a short 4th metacarpal of the right hand, and short 3rd and 4th metacarpals of the left hand.
Image credit: National Human Genome Research Institute (NHGRI), Elements of Morphology; cropped from original figure.
Definition (Short metacarpal)
Subjective: Diminished length of one or more metacarpal bones in relation to the others of the same hand or to the contralateral metacarpal.
Note: Short metacarpals can involve any of the metacarpal bones, and the affected ray should be specified. The assessment of isolated short metacarpal can be made by viewing the dorsum of the hand when clenched. Note that if metacarpals F2–5 are affected, the correct term is Short palm.
Conditions with potential psychiatric associations
Selected references and further reading — Morphologic lens
Allanson JE, Biesecker LG, Carey JC, Hennekam RCM. Elements of morphology: introduction. Am J Med Genet A. 2009;149A(1):2-5.
Hennekam RCM, Biesecker LG, Allanson JE, Hall JG, Opitz JM, Temple IK, Carey JC; Elements of Morphology Consortium. Elements of morphology: general terms for congenital anomalies. Am J Med Genet A. 2013;161A(11):2726-2733.
Jones KL, Jones MC, del Campo M. Smith's recognizable patterns of human malformation. 8th ed. Philadelphia: Elsevier; 2021.
Reardon W. The bedside dysmorphologist: a guide to identifying and assessing congenital malformations. 2nd ed. Oxford: Oxford University Press; 2016.