eMedicine Specialties > Clinical Procedures > Musculoskeletal Procedures

Joint Reduction, Thumb Dislocation

Author: Moira Davenport, MD, Attending Physician, Departments of Emergency Medicine and Orthopedic Surgery, Allegheny General Hospital
Contributor Information and Disclosures

Updated: Jun 26, 2009

Introduction

Despite the inherent stability of the joints of the thumb, the vulnerable anatomic position of the first phalangis often subjects the joints to mechanical strain that leads to subluxation or dislocation of the metacarpophalangeal (MCP) and interphalangeal (IP) joints.

Anatomic locations of the joints of the thumb.

Anatomic locations of the joints of the thumb.

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Anatomic locations of the joints of the thumb.

Anatomic locations of the joints of the thumb.



The MCP joint of the thumb is a condyloid joint with a structurally stronger capsular ligament apparatus then the other 4 MCP joints of the hand.1 Most thumb MCP dislocations are dorsal.2 They are caused by a longitudinal and dorsal stress along the axis of the digit that hyperextends the thumb and tears the volar plate of the joint. An example of this mechanism is a fall onto an outstretched hand (FOOSH) with an impact to the tip of an extended thumb.

Volar dislocation of the MCP joint of the thumb is comparatively rare and is associated with tears of both dorsal capsule ligaments and the extensor pollicis brevis (EPB). For this reason, anterior dislocations are often treated with surgical repair of the torn structures, and closed reduction is rarely achieved with adequate postreduction stability.

Plain film radiography is the definitive diagnostic modality for joint dislocations of the thumb, serving to describe the geography of the dislocation and to rule out the possibility of coexisting fractures. Intra-articular fractures should be excluded by radiology prior to attempting to reduce a joint in the thumb. These fractures include the Bennett fracture or oblique fracture through the base of the first metacarpal with dislocation of the radial portion of the articular surface.3 The Rolando fracture is similar to the Bennett fracture except that the fracture at the base of the metacarpal is comminuted with similar dislocation of the fragments.

Dislocation of the IP joint occurs to a much lesser extent than dislocation of the MCP joint. These injuries are most commonly dorsal and are often associated with disruption of the overlying skin and soft tissues.

Although rare cases of multiple simultaneous thumb joint dislocations, including the IP, MCP, and the proximal carpometacarpal (CMC) or trapeziometacarpal joint, have been reported in the literature, most thumb dislocations involve only a single joint.4,5,6 The existence of multiple thumb joint dislocation injury underscores the necessity of careful radiographic analysis before reduction attempts are made.7

Indications

  • Radiographic evidence of dorsal dislocation of the first metacarpophalangeal (MCP) or interphalangeal (IP) joint with no simultaneous radiographic evidence of intraarticular fracture of the carpals, the first metacarpal, or the first proximal or distal phalanx
  • Clinical history and examination consistent with acute dislocation of the MCP or IP joint of the thumb with significant neurovascular deficits on examination that began at any time after the injury (In this emergent scenario, reduction should not be delayed to acquire radiologic assessment.)

Contraindications

Absolute contraindications

  • Simultaneous intraarticular fracture of the carpals, the first metacarpal, or the first proximal or distal phalanx
  • Epiphyseal plate injury of the carpals, the first metacarpal, or the first proximal or distal phalanx

Relative contraindications

  • Persistence of nonossified physeal plate in a dislocation that does not reduce with minimal force
  • Volar dislocations of the metacarpophalangeal (MCP) or interphalangeal (IP) joint of the first digit8

More on Joint Reduction, Thumb Dislocation

Overview: Joint Reduction, Thumb Dislocation
Treatment & Medication: Joint Reduction, Thumb Dislocation
Multimedia: Joint Reduction, Thumb Dislocation
References
Further Reading
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References

  1. Bosmans B, Verhofstad MH, Gosens T. Traumatic thumb carpometacarpal joint dislocations. J Hand Surg [Am]. Mar 2008;33(3):438-41. [Medline].

  2. Maheshwari R, Sharma H, Duncan RD. Metacarpophalangeal joint dislocation of the thumb in children. J Bone Joint Surg Br. Feb 2007;89(2):227-9. [Medline].

  3. Dillon JP, Laing AJ, Thakral R, Buckley JM, Mahalingam K. Volar dislocation of the index carpometacarpal joint in association with a Bennett's fracture of the thumb: a rare injury pattern. Emerg Med J. Mar 2006;23(3):e23. [Medline].

  4. Drosos GI, Kayias EH, Tsioros K. "Floating thumb metacarpal" or complete dislocation of the thumb metacarpal: a case report and review of the literature. Injury. May 2004;35(5):545-8. [Medline].

  5. Khan AM, Ryan MG, Teplitz GA. Bilateral carpometacarpal dislocations of the thumb. Am J Orthop. Jan 2003;32(1):38-41. [Medline].

  6. Vashista GN, Krishnan KM, Deshmukh SC. Simultaneous dislocations of the carpometacarpal and metacarpophalangeal joints of the thumb. Injury Extra. 2004;35:56-8. [Full Text].

  7. Shih KS, Tsai WF, Wu CJ, Mudgal C. Simultaneous dislocation of the carpometacarpal and metacarpophalangeal joints of the thumb in a motorcyclist. J Formos Med Assoc. Aug 2006;105(8):670-3. [Medline].

  8. Catalan-Amigo S, Pedemonte-Jansana J, Navarro-Quilis A. Simultaneous dislocation of both joints of the thumb with a fracture involving the interphalangeal joint. A case report and a review of the literature. Acta Chir Belg. Nov-Dec 2007;107(6):728-30. [Medline].

  9. Hirata H, Takegami K, Nagakura T, Tsujii M, Uchida A. Irreducible volar subluxation of the metacarpophalangeal joint of the thumb. J Hand Surg [Am]. 2004;29(5):921-4. [Medline].

  10. Verhelle N, Van Ransbeeck H, De Smet L. Irreducible dislocation of the interphalangeal joint of the thumb: a case report. Eur J Emerg Med. Dec 2003;10(4):347-8. [Medline].

  11. Hong E. Hand injuries in sports medicine. Prim Care. 2005;32(1):91-103. [Medline].

  12. Chudnofsky R, Carl, Byers, Stacie. Splinting Techniques. In: Roberts: Clinical Procedures in Emergency Medicine. 4th ed. Elsevier Mosby Publishing; 2004:997-8.

  13. Jobe MT, Calandruccio JH. Ch 64. In: Canale ST. Campbell's Operative Orthopaedics. 10th ed. St. Louis, Mo: Mosby Inc; 2003:3490-4.

  14. Posner MA. The Hand. In: Scuderi GR, McCann PD. Sports Medicine, A Comprehensive Approach. 2nd ed. Elsevier Mosby Publishing; 2005:299-303.

  15. Seiler JG. Chapter 12. In: Essentials of Hand Surgery. 3rd ed. Philadelphia, Pa: Lippincott Williams and Wilkins; 2002:90-8.

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Further Reading

Chudnofsky RC, Byers S. Thumb spica splint. In: Roberts, ed. Clinical Procedures in Emergency Medicine. 4th ed. Elsevier; 2004:997-998.

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Keywords

thumb dislocation, thumb relocation, thumb reduction, metacarpophalangeal dislocation, metacarpophalangeal relocation, metacarpophalangeal reduction, Stener lesion, Bennett fracture, Rolando fracture, subluxation, interphalangeal dislocation, volar dislocation, thumb joint, MCP, IP, MCP dislocation, IP dislocation, valgus strain

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Contributor Information and Disclosures

Author

Moira Davenport, MD, Attending Physician, Departments of Emergency Medicine and Orthopedic Surgery, Allegheny General Hospital
Moira Davenport, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Luis M Lovato, MD, Associate Clinical Professor, David Geffen School of Medicine at UCLA; Director of Critical Care, Department of Emergency Medicine, Olive View/UCLA Medical Center
Luis M Lovato, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

Gil Z Shlamovitz, MD, Assistant Professor of Emergency Medicine, University of Connecticut School of Medicine; Attending Physician, Emergency Department, Windham Community Memorial Hospital, Willimantic, CT; Attending Physician, Emergency Department, Hartford Hospital, Hartford, CT
Gil Z Shlamovitz, MD is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians
Disclosure: Nothing to disclose.

Chief Editor

Erik D Schraga, MD, Consulting Staff, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates; Consulting Staff, Permanente Medical Group, Kaiser Permanente, Santa Clara Medical Center
Disclosure: Nothing to disclose.

 
 
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