A 36-year-old woman was referred to our clinic in May 2005 with a 1-year history of pain in her left hand. The pain was constant but increased at night and after manual labor, and was reduced by non-steroidal anti-inflammatory agents. There was no history of injury. There was a tender swelling of the head of the third metacarpal bone in the dorsum of the left hand at physical examination. The range of motion was not limited and there were no sensory disturbances. The grip strength of the left hand was slightly reduced, mainly due to pain. Blood count and biochemical profile were within the reference ranges. The radiograph showed an oval nidus surrounded by a radiolucent ring. Computed tomography (CT) of the left hand clearly showed an oval radiolucent zone at the head of the third metacarpal bone and marked sclerosis around the lesion. The history and clinical and radiographic findings pointed to the diagnosis of an osteoid osteoma of the head of the third metacarpal bone in the left hand. The patient was operated on 30 days later, by a dorsal approach, under a brachial plexus block. An en bloc excision of the nidus was performed using a small curette. A high-speed burr was also used to remove the sclerotic bone inside the lesion. The defect was filled with an autogenous cancellous bone graft. The hand was immobilized postoperatively with a splint. Histological examination confirmed the diagnosis of osteoid osteoma. The pain disappeared immediately after the operation. At the 2-year follow-up, the patient was pain-free and there was no evidence of recurrence.