Ligament Injuries Of The Finger Metacarpophalangeal Joint

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Unlike PIP joint injuries, dislocations and ligamentous injuries of the MP joint are uncommon. The location of the joint at the base of the digits and ligamentous restraints play an important role in the stability of the MP joint. Except for the absence of the check-rein structures, the ligamentous design of the MP joint is similar to that of the PIP joint already described. It is important to note that the volar plate of the MP joint is firmly attached distally to the proximal phalanx. The proximal metacarpal insertion is not anchored as well. Dorsally, a thin capsule is present but reinforced by overlying extensor tendons.

Dorsal dislocation of the MP joint is most commonly seen within the border digits. The mechanism of injury is usually a hyperextension force of the finger. The proximal membranous portion of the volar plate becomes detached and is interposed between the base of the proximal phalanx and the metacarpal head. Prior to closed reduction, the clinician must attempt to distinguish between simple and complex dislocations. Complex dorsal dislocations require open reduction. Athletes with simple dislocations present with the injured digit hyperextended 60 to 80 degrees. In complex dislocations, the injured digit is found to be in 10 to 15 degrees of extension and slight deviation toward the more central ray. Occasionally, puckering or dimpling within the palmar skin is seen. Closed reduction of simple MP dislocations is performed by flexing the wrist and applying a distally and volarly directed pressure to the base of the dislocated phalanx.65,66 These injuries are managed with a dorsal blocking splint, permitting active flexion exercises. Complex dislocations require an open reduction, usually through a volar approach.

Collateral ligament injuries of the MCP joint are uncommon. The mechanism of injury is usually an ulnarly directed force on a flexed MCP joint. The injury most commonly occurs in the long, ring, and small fingers. Clinically, the athlete presents with pain and swelling along the radial side of the MCP joint. To assess for injuries of the proper collateral ligament, the MCP joint is brought into flexion and an ulnar directed stress is applied. A Brewerton view radiograph of the injured hand can be helpful to assess for avulsion fractures.67 In cases of significant instability, consideration of direct primary repair of the ligament may be given to RCL injuries of the border digits68 (Fig.

Brewerton View Hand Ray

Figure 41-21 Magnetic resonance imaging of the hand in a 38-year-old indoor soccer player who sustained an ulnar-side stress to the index finger when he hit the retaining wall of the field. The imaging study demonstrates complete disruption of the radial collateral ligament of the index finger metacarpophalangeal joint with associated ulnar subluxation of the joint.

Figure 41-21 Magnetic resonance imaging of the hand in a 38-year-old indoor soccer player who sustained an ulnar-side stress to the index finger when he hit the retaining wall of the field. The imaging study demonstrates complete disruption of the radial collateral ligament of the index finger metacarpophalangeal joint with associated ulnar subluxation of the joint.

41-21). The majority of complete ligamentous injuries respond to a 2- to 3-week period of immobilization in slight flexion, followed by protective buddy taping. Most incomplete MCP joint collateral ligament injuries and complete tears in nonborder digits heal with immediate protective buddy taping, early ROM, and return to play.

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