PMC4855740_01
(a) The locked MCPJ at the time of presentation with limitation of extension at MCPJ. (b) Full flexion is possible. (c) The way the patient opens the caps of specimen bottles in the laboratory. (d) Plain c-rays of both hands showing bilateral radial sesamoids of the index fingers with no displacement of the sesamoids. (e) MRI (T2 images) showing hyper-intensity around the radial sesamoids of the left index finger with impingement with bony prominence of the radial condyle of the metacarpal head (arrow). (f) The excised sesamoid and the surrounding palmar plate. (g) Excision exposed the metacarpal head. (h) Full extension of the finger immediately following sesamoid excision. (i and j) Full range of motion at 6 months.
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A 32-year old female laboratory technician presented with a three-week history of locked MCPJ of the left index finger in 45  of flexion (Fig. 1A). No further extension at the MCPJ was possible, but she was able to flex the finger fully (Fig. 1B). The patient worked in the laboratory for 6 years and has been opening the caps of specimen bottles using the left hand repeatedly as shown in Fig. 1C. Plain x-rays of both hands showed bilateral symmetrical radial sesamoid bones of the index fingers with no displacements of the sesamoids (Fig. 1D). MRI showed synovitis around the radial sesamoid with impingement to the normal bony prominence of the radial condyle of the metacarpal head (Fig. 1E). The radial sesamoid and its surrounding palmar plate were then excised via a palmar incision (Fig. 1F and G). Immediately following sesamoid excision, full extension of the finger was obtained without any attempts of reducing the MCPJ (Fig. 1H). She is now six months after surgery with no recurrence of the locking (Fig. 1I and J).