Metacarpophalangeal Joint Denervation in the Treatment of Dieterich Disease: A Case Report

Abstract

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.

DIETERICH’s disease of both the third and the fourth metacarpal head in a teenage boy: case report and review of literature

“…In case of a surgical treatment, the status of the cartilage and extend of its damage, determines the type of surgery chosen. Surgical procedures described in literature are for example: curettage and bone grafting [ 11 ]; denervation of the metacarpal joint [ 8 ]; osteochondral auto graft transfer system [ 12 ]; pyrolytic carbon hemiarthroplasty of the metacarpal head [ 13 ]; osteochondral mosaicplasty [ 14 ]; and joint fusion [ 6 ]. All these procedures are case reports; there is no consensus and there are no long-term results available in the literature concerning surgical treatment of the Dieterich’s disease.…”

Current management of avascular necrosis of the metacarpal head: a comprehensive literature review

“…Meanwhile, all palmar sensory articular branches are divided from the radial and ulnar digital nerves 59 . Bailey applied the MCP joint denervation technique to a patient with avascular necrosis of the metacarpal head, who achieved satisfactory pain relief and grip strength 60 . Surgeons should be aware of the potential for painful neuroma dorsally and neurapraxia of the digital nerves when applied MCP joint denervation 59 .…”

Operative Therapie der avaskulären Nekrose des Metakarpalekopfes (M. Dieterich) mittels eines osteochondralen Zylinders aus dem ipsilateralen Os pisiforme: Ein Fallbericht

“…Bei gescheiterter konservative Therapie gibt es zahlreiche operative Behandlungsansätze. Diese reichen von Gelenkdenervation [10], Debridement kombiniert mit Spongiosaplastik [11,12], über Umstellungsosteotomien, Resektionsarthroplastiken, dem künstlichen Gelenkersatz [13] bis hin zur Transplantation eines Metatarsalekopfes [14] und Rippenknorpeltransplantaten [15].…”