Metacarpal Pain Unveiled: A Case Report and Literature Review of Dietrich’s Disease in Adolescence

TL;DR

This case report describes a rare condition called Dietrich's disease in a 15-year-old boy, focusing on diagnosis and treatment to preserve hand function.

Contribution

The paper presents a detailed case report and literature review of Dietrich’s disease in adolescence, emphasizing diagnostic and management insights.

Findings

Radiographic and MRI findings confirmed avascular necrosis in the fourth metacarpal head of a 15-year-old male.

Dietrich's disease should be considered in adolescents with metacarpal pain and a history of trauma or steroid use.

Early detection and multidisciplinary management are crucial for optimizing outcomes in adolescent patients.

Abstract

Dietrich's disease, also known as Mauclaire’s disease, is a rare condition characterized by avascular necrosis of the metacarpal heads, predominantly affecting adolescents. This case report aims to elucidate the diagnostic process and management of Dietrich's disease in adolescents.

A 15-year-old male adolescent presented with left ring finger metacarpophalangeal joint pain and restricted range of motion following a remote history of sports-related trauma. Clinical examination revealed tenderness and limited flexion at the affected joint. Radiographic evaluation demonstrated characteristic features of Dietrich's disease, including lucency and loss of height in the fourth metacarpal head and volar subluxation of the ring finger.

Computed tomography and magnetic resonance imaging (MRI) confirmed the diagnosis, revealing flattening of the metacarpal head, subchondral marrow edema, and joint effusion consistent with avascular necrosis.

The pathogenesis of Dietrich's disease remains incompletely understood, likely involving acquired deficits in arteriolar blood supply. Radiographic and MRI findings aid in diagnosis, distinguishing it from other conditions such as chondroblastoma and osteomyelitis. Treatment options range from conservative management to surgical interventions, depending on the severity of symptoms.

Dietrich's disease, though rare, should be considered in adolescents presenting with metacarpal pain and predisposing factors such as trauma or steroid use. Recognition of characteristic imaging features is essential for accurate diagnosis and appropriate management in adolescent populations. This case highlights the importance of early detection and multidisciplinary management in adolescents with Dietrich's disease to optimize outcomes and preserve hand function.

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