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Metacarpophalangeal Joint Dislocation Treatment & Management

  • Author: Matthew Gammons, MD; Chief Editor: Craig C Young, MD  more...
 
Updated: Mar 27, 2014
 

Acute Phase

Rehabilitation Program

Occupational Therapy

Finger metacarpophalangeal (MCP) joint collateral ligament sprains should not be overtreated. First-degree sprains may require a brief period of protection, usually consisting of buddy taping for 2-3 weeks. Second-degree sprains are immobilized in mid flexion for 3 weeks.

Finger MCP joint hyperextension injuries may be treated by gently flexing the proximal phalanx and immobilizing the MCP joint in 30° of flexion for 2-3 weeks. A dorsal extension-block splint protects the healing volar plate while allowing active flexion of the finger. Early protected motion minimizes postinjury stiffness.

Thumb MCP joint hyperextension injuries ("locked MCP joint") are immobilized in 20° MCP joint flexion for 3 weeks.

After closed reduction, a dorsal extension-block splint, including the wrist, is used for at least 3 weeks in MCP joint dorsal dislocations. Active motion within the splint is started during the first week. Following closed reduction, the thumb is immobilized in a forearm-based thumb spica splint or cast with the MCP joint in extension for 4-6 weeks in thumb MCP joint volar dislocations.

Thumb radial collateral ligament injuries may be treated in a forearm-based or hand-based thumb spica cast for 4 weeks.

Surgical Intervention

After open reduction surgical repair, postoperative immobilization and therapy are similar to those that are recommended after closed reduction. In finger MCP joint collateral ligament injuries, surgical repair is indicated for gross instability (third-degree sprain) or a significantly displaced or rotated avulsion fracture.

MCP joint complex dorsal dislocations require open reduction in the operating room. This reduction may be accomplished with a palmar or dorsal approach. A dorsal longitudinal incision affords easy visualization of the interposed volar plate and avoids the digital neurovascular bundles that are more susceptible to injury with the palmar approach.

Volar MCP joint dislocations are extremely rare. The volar plate or dorsal capsule may be interposed into the joint, which usually requires open surgical reduction. Immobilization for 3-4 weeks in extension is recommended after successful reduction.

In thumb MCP joint dorsal dislocations, open reduction through a dorsal approach is indicated for failed closed reduction.[11] A dorsal approach is also used for failed closed management of a locked thumb MCP joint injury. In thumb MCP joint volar dislocations, surgical repair should be considered for chronic dislocations or when postreduction radiographs demonstrate persistent volar subluxation of the MCP joint. In thumb radial collateral ligament injuries, significant laxity (>30°) or volar subluxation is an indication for surgical repair.

Consultations

Immediate consultation with an orthopedic or hand surgeon is indicated for open or irreducible dislocations or when neurovascular compromise of the digit is present. After successful closed reduction, follow-up within 1 week should be arranged with an orthopedic or hand surgeon.

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Recovery Phase

Rehabilitation Program

Occupational Therapy

After the appropriate immobilization period, progressive hand therapy is initiated.

  • Finger MCP joint collateral ligament: Second- and third-degree sprains are protected with buddy taping for an additional 3 weeks.
  • Finger MCP joint hyperextension injuries: The injured digit is buddy taped to an uninjured finger for an additional 2-3 weeks.
  • MCP joint dislocations: Progressive motion and gradual weaning from the splint are performed over 3 weeks.
  • Thumb radial collateral ligament: Protected motion in flexion/extension and gradual weaning from the splint are performed over 2 weeks.

Surgical Intervention

Significant collateral ligament laxity that interferes with hand function may require surgical reconstruction after an appropriate time period for normal healing has lapsed. Excessive joint contractures unresponsive to occupational therapy may require surgical release.

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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, American Society of Mechanical Engineers

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

Russell D White, MD Clinical Professor of Medicine, Clinical Professor of Orthopedic Surgery, 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, American Medical Society for Sports Medicine

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, 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, Phi Beta Kappa

Disclosure: Nothing to disclose.

Additional Contributors

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, Santa Clara County Medical Association, Monterey County Medical Society

Disclosure: Received ownership interest from South Bay Sports and Preventive Medicine Associates, Inc for board membership.

Acknowledgements

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. 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. 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. 2006 Aug. 22(3):357-64, viii. [Medline].

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

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

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

  7. KAPLAN EB. Dorsal dislocation of the metacarpophalangeal joint of the index finger. J Bone Joint Surg Am. 1957 Oct. 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]. 1988 Nov. 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. 2011 Apr. 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). 2008 Apr. 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. 2009 May. 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. 2007 Feb. 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. 2008 Mar. 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]. 2008 Apr. 33(4):555-7. [Medline].

  16. Peterson JJ, Bancroft LW. Injuries of the fingers and thumb in the athlete. Clin Sports Med. 2006 Jul. 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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