Avascular necrosis of the sesamoid bone of the second metacarpophalangeal joint - a literature review and therapy recommendations.

Introduction: Avascular necrosis of the sesamoid bones in the hand is a very rare and painful condition that is often associated to overuse or circulatory disturbances. The literature on its etiology, cause, and frequency remains sparse. This condition is more commonly observed in the femoral head or metacarpal head, while sesamoid necrosis of the hand is less frequently to not at all discussed. This study explores the causes, symptoms, diagnosis, and treatment options for this rare condition, presenting a case of a 76-year-old woman diagnosed with avascular necrosis of the sesamoid bone in the index finger. Material and methods: An extensive literature review was conducted using PubMed and Google Scholar, yielding 82 publications from 1990 to 2024. Of these, 80 were excluded due to being related to the foot. A retrospective analysis of the remaining two articles focused on the conservative and surgical treatments for sesamoid necrosis in the hand. The data include demographic information, diagnosis, and treatment outcomes. Results: Over the past 35 years, only two cases of avascular necrosis of the sesamoid bones in the hand have been documented. Both previous reports involved female patients presenting with symptoms of grip weakness and progressive pain at the metacarpophalangeal (MCP) joint. In the two reported cases, conservative treatments such as Non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and physical therapy were initially applied but ultimately proved ineffective. Surgical intervention, including sesamoidectomy, was required to alleviate symptoms, with all diagnoses confirmed through pathological examination. Conclusion: Avascular necrosis of the sesamoid bones in the hand, though rare, can lead to significant pain and functional impairment. Conservative treatments can provide short-term symptom relief, but they have been insufficient for long-term pain management or functional restoration in the few cases reported worldwide. Surgical intervention, specifically sesamoidectomy, remains the definitive treatment for achieving lasting relief. Early intervention is recommended to prevent long-term disability, chronic pain and resulting infection.