Abstract. A 37-year old woman presented with intolerable pain associated with a slowly growing mass on the dorsum of the right hand. The radiographs were characteristic of melorheostosis involving the third and fourth metacarpals, with a cortical bony projection extending from the base of the third metacarpal eroding slightly into the fourth metacarpal, associated with bursal formation. Magnetic resonance imaging (MRI) demonstrated an inflamed bursal collection adjacent to the spur. This region corresponded to the patient's severe clinical, focal pain. To our knowledge, this is the first case report in which melorheostosis of the hand has been associated with bony spur formation and complicated by an inflamed bursa.