Avascular necrosis of the third metacarpal head is a rare entity. It may remain asymptomatic, but may also be painful and lead to restricted range of motion. A-thirteen-year-old male patient presented with a painful and restricted range of motion in the third metacarpophalangeal (MCP) joint. There was no history of any trauma or a predisposing factor such as systemic lupus erythematosus or steroid use. The range of motion of the involved joint was minimally restricted (flexion range, 10 to 80 degrees). Mild tenderness was found on palpation over the dorsal aspect of the third MCP joint. Radiographs showed flattening and sclerosis of the third metacarpal head together with cystic lesions. The symptoms were controlled with non-steroidal anti-inflammatory drugs and splinting for four weeks. The range of motion of the MCP joint increased, along with regression on radiographs.