Metacarpophalangeal Joint Dislocation Clinical Presentation

  • Author: Matthew Gammons, MD; Chief Editor: Craig C Young, MD   more...
 
Updated: Mar 27, 2012
 

History

Finger metacarpophalangeal joint dislocation (MCP) joint

The border digits (index and small) are more susceptible to injury, particularly in extension when either finger is less protected by neighboring digits and the collateral ligaments are lax.

Sudden forces that push the finger into ulnar deviation or hyperextension may lead to collateral ligament sprain, a torn volar plate, or frank dislocation of the MCP joint.

Sudden deviation or twisting of the finger may cause collateral ligament injury. The 3 ulnar digits are affected more commonly than the index finger.

Thumb MCP joint

Similar to the MCP joint of the fingers, dorsal dislocations of the thumb MCP joint are more common than volar dislocations.

Some patients present with a history of a probable dislocation that was reduced at the time of injury. A number of case reports have described 2 level dislocations of the thumb in higher-energy trauma: simultaneous interphalangeal and MCP joint dislocation[8] or MCP joint dislocation in association with dislocation or fracture -dislocation of the carpometacarpal joint (Bennett fracture).

Sprains or ruptures of the collateral ligaments of the thumb involve the radial structures 25-40% of the time; most injuries to the thumb affect the ulnar collateral ligament. A sudden adduction force on the MCP joint after a direct fall onto the thumb or palm leads to a partial or complete rupture of the radial collateral ligament.

For information on the ulnar collateral ligament, see Gamekeeper's Thumb and Skier's Thumb.

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Physical

Finger MCP joint hyperextension injury

A mild hyperextension force may cause stretching or a complete tear of the proximal membranous origin of the volar plate.

The MCP joint may be resting in 60º of hyperextension.

The patient demonstrates tenderness over the volar MCP joint with direct pressure or passive extension of the finger.

The examiner must avoid applying traction or a hyperextension force that could convert the hyperextension into a dislocation.

Finger MCP joint dorsal dislocation

The proximal phalanx sits dorsally over the metacarpal head. The MCP joint may be slightly hyperextended, and the interphalangeal joints are flexed slightly.

The prominent metacarpal head can be palpated in the palm. The adjacent skin may be puckered.

Finger MCP joint collateral ligament injury

The general classification of these injuries is as follows:

  • A first-degree sprain has minimal ligament injury and manifests as tenderness with no laxity.
  • A second-degree sprain has a partial tear and manifests as tenderness with mild laxity.
  • A third-degree sprain has complete ligament rupture and manifests as tenderness, swelling, and gross instability.

Thumb MCP joint dislocation

Similar to the MCP joint of the fingers, dorsal dislocations of the thumb MCP joint are more common than volar dislocations.

The proximal phalanx rests dorsal to the metacarpal interphalangeal joint in mild flexion.

The metacarpal head is palpable in the palm.

Thumb MCP joint radial collateral ligament

Tenderness and swelling over the radial and dorsoradial aspect of the joint is present, as the dorsal capsule is often involved in this injury complex.

Progressive laxity leads to an ulnar-deviated thumb position.

Decreased pinch strength is present, even with mild ligament injury.

Locked MCP joint of the thumb [9]

Less frequently, a hyperextension force to the thumb may cause the thumb to lock in that position, without actually dislocating the joint.

The torn volar plate and accessory collateral ligament may become entrapped on a prominence of the radial condyle of the metacarpal head.

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Causes

MCP joint dislocations are usually caused by forced hyperextension of the digit. Radial collateral ligament injuries occur during forced ulnar deviation of a flexed MCP joint.

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Contributor Information and Disclosures
Author

Matthew Gammons, MD  Assistant Clinical Professor, Department of Family and Community Medicine, Medical College of Wisconsin; Medical Director, Castleton State College; Consulting Staff, Vermont Orthopaedic Clinic and Killington Medical Clinic

Matthew Gammons, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, and American Society of Mechanical Engineers

Disclosure: Nothing to disclose.

Specialty Editor Board

Anthony J Saglimbeni, MD  President, South Bay Sports and Preventive Medicine Associates; Private Practice; Team Internist, San Francisco Giants; Team Internist, West Valley College; Team Physician, Bellarmine College Prep; Team Physician, Presentation High School; Team Physician, Santa Clara University; Consultant, University of San Francisco, Academy of Art University, Skyline College, Foothill College, De Anza College

Anthony J Saglimbeni, MD, is a member of the following medical societies: California Medical Association and Santa Clara County Medical Association

Disclosure: South Bay Sports and Preventive Medicine Associates, Inc Ownership interest Other

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Russell D White, MD  Professor of Medicine, Professor of Orthopedic Surgery, Director of Sports Medicine Fellowship Program, Medical Director, Sports Medicine Center, Head Team Physician, University of Missouri-Kansas City Intercollegiate Athletic Program, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center-Lakewood

Russell D White, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Family Physicians, American Association of Clinical Endocrinologists, American College of Sports Medicine, American Diabetes Association, and American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Jon B Whitehurst, MD  Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital

Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America

Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD  Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Director of Primary Care Sports Medicine Fellowship, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, David R Steinberg, MD, to the development and writing of this article.

References

  1. Glickel SZ, Barron OA, Eaton RG. Dislocations and ligament injuries in the digits. In: Green DP, Hotchkiss RN, Pederson WC, eds. Green's Operative Hand Surgery. 4th ed. New York, NY: Churchill Livingstone; 1999:772-807.

  2. Neviaser RJ. Dislocations and ligamentous injuries of the digits. In: Chapman MW, ed. Operative Orthopaedics. 2nd ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 1993:1237-50.

  3. Lourie GM, Gaston RG, Freeland AE. Collateral ligament injuries of the metacarpophalangeal joints of the fingers. Hand Clin. Aug 2006;22(3):357-64, viii. [Medline].

  4. Zemel NP. Metacarpophalangeal joint injuries in fingers. Hand Clin. Nov 1992;8(4):745-54. [Medline].

  5. Melone CP Jr, Beldner S, Basuk RS. Thumb collateral ligament injuries. An anatomic basis for treatment. Hand Clin. Aug 2000;16(3):345-57. [Medline].

  6. Posner MA, Retaillaud JL. Metacarpophalangeal joint injuries of the thumb. Hand Clin. Nov 1992;8(4):713-32. [Medline].

  7. Kaplan EB. Dorsal dislocation of the metacarpophalangeal joint of the index finger. J Bone Joint Surg Am. Oct 1957;39-A(5):1081-6. [Medline]. [Full Text].

  8. Tabib W, Sayegh S. Simultaneous dislocation of the metacarpophalangeal and interphalangeal joints of the thumb. Scand J Plast Reconstr Surg Hand Surg. 2002;36(6):376-8. [Medline].

  9. Inoue G, Miura T. Locked metacarpo-phalangeal joint of the thumb. J Hand Surg [Br]. Nov 1988;13(4):469-73. [Medline].

  10. Beck JD, Klena JC. Closed reduction and treatment of 2 volar thumb metacarpophalangeal dislocations: report of 2 cases. J Hand Surg Am. Apr 2011;36(4):665-9. [Medline].

  11. Ip KC, Wong LY, Yu SJ. Dorsal dislocation of the metacarpophalangeal joint of the thumb: a case report. J Orthop Surg (Hong Kong). Apr 2008;16(1):124-6. [Medline]. [Full Text].

  12. Dinh P, Franklin A, Hutchinson B, Schnall SB, Fassola I. Metacarpophalangeal joint dislocation. J Am Acad Orthop Surg. May 2009;17(5):318-24. [Medline].

  13. 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].

  14. Marcotte AL, Trzeciak MA. Nonoperative treatment for a double dislocation of the thumb metacarpal: a case report. Arch Orthop Trauma Surg. Mar 2008;128(3):281-4. [Medline].

  15. Orozco JR, Rayan GM. Complex dorsal metacarpophalangeal joint dislocation caused by interosseous tendon entrapment: case report. J Hand Surg [Am]. Apr 2008;33(4):555-7. [Medline].

  16. Peterson JJ, Bancroft LW. Injuries of the fingers and thumb in the athlete. Clin Sports Med. Jul 2006;25(3):527-42, vii-viii. [Medline].

 
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Metacarpophalangeal joint dislocation of the small finger. Posteroanterior radiograph demonstrates loss of joint space.
Metacarpophalangeal joint dislocation of the small finger. Oblique radiograph best demonstrates dorsal dislocation of proximal phalanx.
Metacarpophalangeal joint dislocation of the small finger. Dorsally dislocated proximal phalanx is obscured by other digits. Note that the small finger metacarpal sits palmar to the other metacarpals.
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