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Avascular necrosis of the metacarpal head, known as Dieterich disease, is rare. The underlying pathogenesis of the disease is not clearly understood, and there are few cases reported in the literature. Nonoperative treatment with rest and nonsteroidal anti-inflammatory drugs is often successful, but surgical management is sometimes indicated. The case outlined here describes a novel application of the known technique of metacarpophalangeal joint denervation to relieve pain while maintaining joint mechanics and grip strength.

Presented is the third known case of a group C streptococcal arthritis, this case documented in a healthy 42-year-old horse trainer, apparently transmitted by a mare. After a delayed diagnosis, the patient responded favorably to surgical drainage and parenteral penicillin G, but required a manipulation of his knee under general anesthesia. Although rare, group C streptococcal arthritis can occur in hosts with no apparent predisposing factors. Frequent exposure to farm animals may increase the risk.