Here is a patient with the taut and shiny skin typical of sclerodactyly. The skin becomes inelastic and it is hard to move the fingers. If sclerodactyly is seen along with calcinosis, Raynaud phenomenon, esophageal dysmotility, and telangietasias, then the best diagnosis is CREST syndrome ("limited" scleroderma). [Image contributed by Elizabeth Hammond, MD, University of Utah]