Radiographs of the hand of 53 patients with diffuse idiopathic skeletal hyperostosis (DISH) were compared with 20 acromegalic subjects and 100 matched controls. Bone qualitative changes, characteristic of DISH, include: (1) arrow-heading of the distal phalangeal tufts; (2) enthesopathy of the proximal phalanges; (3) enlarged sesamoid bones; (4) hook-like exostoses at the metacarpophalangeal heads; (5) cortical thickness of diaphyseal tubular bones. Therefore, the hand in this disease appears as a "robust" form, particularly in males, resembling acromegalic pattern, but in this disease, the hand is much more coarse (so called squared hand), especially because of the soft tissue involvement and articular cartilaginous hypertrophy. Only enthesopathy seems to be the most characteristic and peculiar finding of the disease. Quantitative bone change measurements have demonstrated in DISH that metacarpal and Exton Smith indices differ statistically toward the controls. The hand is wider, but in males bone mass may result the same and in female is shortly reduced. Soft tissue alterations, compared with the controls, are not significant. On the contrary, in acromegaly there is a significant statistical difference in all the quantitative measurements of both the skeletal and soft tissue lesions, compared with the controls and patients affected by DISH.