Workup
Imaging Studies
Radiography of the hands should be included as part of the workup for stiff joints. Although radiography is not helpful in diagnosing intrinsic contracture, it may be useful for ruling out other diagnoses or causes of a contracture.
Shear wave elastography has been studied as a means of achieving a quantitative evaluation of the condition of the intrinsic muscles of the hand. [12]
Media Gallery
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The metacarpal head is uniquely shaped in that it is ovoid in the sagittal plane, and it widens from the dorsal to the volar dimension. The collateral ligaments are eccentrically mounted dorsal to the axis of rotation of the metacarpophalangeal joint. This anatomy causes variable degrees of tightness on the collateral ligaments based on the position of the joint by a camlike effect. When the joint is in extension, the collateral ligaments are lax. In flexion, the collateral ligaments span a greater distance and are tight.
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Proximal interphalangeal (PIP) joint collateral ligaments originate close to the axis of rotation, providing a smaller change in length with joint position and providing lateral stability. The PIP joint ranges in only 1 plane, and its trochlear shape also adds to its lateral stability.
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Edema is the initial response to any insult to the hand and leads to adverse sequelae. Joint stiffness develops as intra-articular hematoma and fluid accumulate within the synovial space, distending the capsule. Increased fluid content within the articular capsule and collateral ligaments effectively shortens these structures, favoring extension.
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With injury, checkreins form at the IP joints. Checkreins are collagenous bands connecting the lateral sides of the proximal volar plate to the assembly lines on the volar lateral surfaces of the phalanx. Assembly lines are the 2 ridges along the volar lateral surfaces of the phalanx to which are attached volar ligamentous structures, such as the flexor sheath, Cleland and Grayson ligaments, and the oblique retinacular ligaments of Landsmeer.
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