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J R Soc Med. 2005 February; 98(2): 87.
PMCID: PMC1079404

The Renaissance fifth finger

Dr Hijmans and Dr Dequeker (November 2004 JRSM1) have presented five 15th century paintings by Dirk Bouts (1410–1475) and his son, Albrecht. Each of these portrays a woman with a distinct deformity of one or both fifth fingers. They have proposed that a single sitter for all of these portraits had camptodactyly, a congenital, often hereditary, fixed flexion of the proximal interphalangeal (PIP) joint of the fifth finger but without flexion of the distal interphalangeal (DIP) joint. This is accompanied by compensatory hyperextension of the metacarpophalangeal joint.2 This conformation of the fifth finger is not physiological. That is, most people cannot flex the PIP joint of the fifth finger without also flexing the DIP joint. It is reasonable, then, to suggest a pathological basis for the fingers in the portraits.

Hijmans and Dequeker dismiss ‘mannerism’ as an explanation, having found no such anomalies in works by other artists of the time. However, I have come across several camptodactyly-like hands in The Metropolitan Museum of Art. Some examples are shown in Figure 1. The artists are, reading left to right from top to bottom, Gerard David (1455–1523), Fillipo Lipi (1406–1469), Hans Memling ((1430–1494), Pietro Perugino (1448–1523), Cosimo Roselli (1439–1507), and Luca Signorelli (1445–1523). It seems that both northern and southern European artists from roughly 1420 to 1520 used this unphysiological affectation, perhaps to imbue the hand with a certain delicacy and grace.

Figure 1
Renaissance hands from the Metropolitan Museum of Art

I suggest that Dirk Bouts and his son were not using a sitter with a pathological deformity, but were simply following the fashion of the time.


1. Hijmans W, Dequeker J. Camptodactyly in a painting by Dirk Bouts (c. 1410-1475). J R Soc Med 2004;97: 549–51 [PMC free article] [PubMed]
2. Wood VE. Camptodactyly. In: Green DP, ed. Operative Hand Surgery, 2nd edn. New York: Churchill Livingstone, 1988: 409–10
2005 February; 98(2): 87.

Authors’ response

Dr Johnson’s examples from the Metropolitan Museum of Art show hyperextension of the metacarpophalangeal joint of the fifth finger in combination with flexion of the proximal interphalangeal joint, but do not present a hyperextension of the distal interphalangeal joint. In two examples a flexion of the peripheral joint can be observed. The criteria of camptodactyly are therefore not met. A stylistic trait, the hallmark of this period, is that the fingers are fine and long, the middle and fourth finger close together and the little finger portrayed with a crooked deformity (clinodactyly). These features are prominent in art works of the school of Rogier van der Weyden in Flanders and of Sandro Botticello in Italy. As mentiond by Dr Johnson, these features can add grace and delicacy. This could well be the case in the picture by a follower of Dirk Bouts (our Figure 7), where the fingers were ‘corrected’. The presentation of the fifth fingers in the elderly lady (our Figure 6) are logically explained by the combination of age and disease.


1. Dequeker J. Medicine Seen Through the Eyes of The Artist. Leuven: Davidsfonds (in press)

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