Metacarpophalangeal Joint

On examination, joint swelling may be visible or may be apparent only by palpation. The tissue feels soft and spongy and may appear erythematous and warm, especially early in the course of the disease. Chronic joint deformities commonly involve subluxations of the wrists, metacarpophalangeal joints, and proximal interphalangeal joints (swan-neck deformity, boutonniere deformity, ulnar deviation). 

Brief History. R.F., a 63-year-old woman, has been receiving treatment for schizophrenia intermittently for many years. She was last hospitalized for an acute episode 7 months ago and has since been on a maintenance dosage of haloperi-dol (Haldol), 25 mg/d. She is also being seen as an outpatient for treatment of rheumatoid arthritis in both hands. Her current treatment consists of gentle heat and active range-of-motion exercises, three times each week. She is being considered for possible metacarpophalangeal joint replacement. 

Figure 1-5 While holding the bottle, the second knuckle of the thumb (interphalangeal joint) of the dominant hand is placed against the first knuckle of the index finger (metacarpophalangeal joint). (From Ritch R, et al. An improved technique of eyedrop self-administration for patients with limited vision. Am J Ophthalmol 2003 135 531-532.)...

Human bites generally are more serious and more prone to infection than animal bites, particularly clenched-flst injuries. While the force of a punch may sever a tendon or nerve or break a bone, it most often causes a breach in the capsule of the metacarpophalangeal joint, leading to direct inoculation of bacteria into thejointorbone. When the hand is relaxed, the tendons carry bacteria into deeper spaces of the hand, resulting in more extensive infection. ... 

Metacarpophalangeal joint flexion-extension axis (Figure 49.33b)... 

Metacarpophalangeal joint abduction-adduction axis (Figure 49.33c)... 

Hollister A., Guirintano D. J., Bulford W.L., et al. 1995. The axes of rotation of the thumb interphalangeal and metacarpophalangeal joints. Clin. Orthop. 320 188. 

Pagowski S. and Piekarski K. 1977. Biomechanics of metacarpophalangeal joint. /. Biomech. 10 205. 

Walker P.S. and Erhman M.J. 1975. Laboratory evaluation of a metaplastic type of metacarpophalangeal joint prosthesis. Clin. Orthop. 112 349. 

Digby, J.M. (1982) Malignant lymphoma with intranodal silicone rubber particles following metacarpophalangeal joint replacements. Hand, 14(3), 326-328. 

Fig. 19.22. Frontal view shows slight misalignment of the index finger metacarpophalangeal joint...

Fig. 19.23. Lateral view reveals the bare metacarpal head indicating metacarpophalangeal joint dislocation...

Fig. 19.25. Avulsion fracture of the ulnar collateral ligament at the thumb metacarpophalangeal joint...

Fig. 19.27. Simple complete dislocation ofthe thumb metacarpophalangeal joint. (Image courtesy of Dr. John Morrison)...

A statistical analysis. Clin Orthop Relat Res 120-130 Johnson KJ, Haigh SF, Symonds KE (2000) MRl in the management of scaphoid fractures in skeletally immature patients. Pediatr Radiol 30 685-688 Kaplan EB (1957) Dorsal dislocation of the metacarpophalangeal joint of the index finger. J Bone Joint Surg Am 39-A 1081-1086... 

Goldfarb, C. A. Stern, P. J. (2003) Metacarpophalangeal joint arthroplasty in rheumatoid arthritis - a long-term assessment. Journal of Bone and Joint Surgery-American Volume, 85, 1869-1878. 

Kirschenbaum, D., Schneider, L. H., Adams, D. C. Cody, R. P. (1993) Arthroplasty of the metacarpophalangeal joints with use of silicone-rubber implants in patients who have rheumatoid arthritis. Long-term results. Journal of Bone and Joint Surgery—American Volume, 75, 3-12. 

Swanson, A. B., Swanson, G. D. Ishikawa, H. (1997) Use of grommets for flexible implant resection arthroplasty of the metacarpophalangeal joint Clinical Orthopaedics and Related Research, 342, 22—33. 

Trail, I. A., Martin, J. A., Nuttall, D. Stanley, J. K. (2004) Seventeen-year survivorship analysis of silastic metacarpophalangeal joint replacement. Journal of Bone and Joint Surgery-British Volume, 86B, 1002-1006. 

Wilson, R. L. Carlblom, E. R. (1989) The rheumatoid metacarpophalangeal joint. Hand Clinics, 5, 223-237. 

Bunnel-LUtler test evaluates the tightness of the intrinsic muscles of the hand. The metacarpophalangeal joint is held in extension and the patient tries to move the proximal interphalangeal joint into flexion. If the proximal interphalangeal joint does not flex, then the intrinsic muscles are tight or the joint capsule is contractured. The metacarpophalangeal joint is rested briefly and then retested. If the proximal interphalangeal joint stUl cannot flex, the problem is in the joint capsule. 

Somatic dysfunction of the wrist permits motion toward the dysfunction motion away from the dysfunction will be restricted. The technique described may be used to test motion of the ra-dionavicular joint and each of the intercarpal joints. It may also be used to test the carpometacarpal and metacarpophalangeal joints. 

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