Metacarpophalangeal dislocation (finger): Difference between revisions
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==Background== | ==Background== | ||
*Usually | [[File:DIP, PIP and MCP joints of hand.jpg|thumb|Distal interphalangeal dislocation (DIP), proximal interphalangeal dislocation (PIP), and metacarpophalangeal dislocation (MCP) joints of the finger shown.]] | ||
[[File:Gray337.png|thumb|Volar/anterior finger anatomy.]] | |||
[[File:Gray338.png|thumb|Lateral finger anatomy.]] | |||
*Also known as the MCP joint | |||
*Usually forces that rupture volar plate cause dorsal dislocation | |||
{{Hand anatomy}} | |||
==Clinical Features== | ==Clinical Features== | ||
*Mechanism: hyperextension | |||
*Finger pain/deformity | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Hand and finger dislocation types}} | {{Hand and finger dislocation types}} | ||
== | {{Hand and finger injury DDX}} | ||
==Evaluation== | |||
===Types=== | ===Types=== | ||
*Simple: subluxation | *Simple: subluxation | ||
**Joint appears hyperextended to 60-90 deg | **Joint appears hyperextended to 60-90 deg | ||
*Complex: dislocation | *Complex: dislocation | ||
**MCP joint is in moderate hyperextension | **MCP joint is in moderate hyperextension with metacarpal head prominent in palm | ||
**Volar plate is interposed in MCP joint space | **Volar plate is interposed in MCP joint space | ||
**X-ray may show seasamoid within joint space (pathognomonic) | **X-ray may show seasamoid within joint space (pathognomonic) | ||
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==Management== | ==Management== | ||
===Reduction=== | ===Reduction=== | ||
* | *Traction alone may convert simple MCP dislocation may convert it to a complex dislocation <ref name="Management of Common Dislocations">Horn A. Management of Common Dislocations. In: Roberts and Hedges' Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Elsevier; 2014. </ref> | ||
*Flex the wrist to relax the flexor tendon | *Dorsal dislocation | ||
*Apply pressure over dorsum of proximal phalanx in distal and volar direction | **Flex the wrist to relax the flexor tendon | ||
**Hyperextend the joint | |||
**Apply pressure over dorsum of proximal phalanx in distal and volar direction | |||
*Volar dislocation | |||
**Rare, will likely need open reduction | |||
**If attempting closed reduction, push finger into the MCP joint and then hyperflex joint | |||
**After hyperflexing, pull traction and extend finger, using thumbs to guide proximal finger into place <ref name="Procedures for orthopedic emergencies">Davenport M. Procedures for orthopedic emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.</ref> | |||
===[[Splinting]]=== | ===[[Splinting]]=== | ||
*Splint | *Splint with MCP joint in flexion | ||
*Refer to hand surgeon | *Refer to hand surgeon within 2 weeks | ||
==Disposition== | ==Disposition== | ||
*Outpatient | *Outpatient management | ||
==See Also== | ==See Also== | ||
Latest revision as of 17:35, 14 December 2022
Background
- Also known as the MCP joint
- Usually forces that rupture volar plate cause dorsal dislocation
Hand Anatomy
- Volar = anterior = dorsal
- Dorsal = posterior = palmar
Clinical Features
- Mechanism: hyperextension
- Finger pain/deformity
Differential Diagnosis
Hand and finger dislocations
- Finger dislocations
- Thumb dislocations
- Hand dislocations
Hand and finger injuries
- Distal finger
- Other finger/thumb
- Boutonniere deformity
- Mallet finger
- Jammed finger
- Jersey finger
- Trigger finger
- Ring avulsion injury
- De Quervain tenosynovitis
- Infiltrative tenosynovitis
- Metacarpophalangeal ulnar ligament rupture (Gamekeeper's thumb)
- Hand
- Wrist
- Drummer's wrist
- Ganglion cyst
- Lunotriquetral ligament instability
- Scaphoid fracture
- Extensor digitorum tenosynovitis
- Compressive neuropathy ("bracelet syndrome")
- Intersection syndrome
- Snapping Extensor Carpi Ulnaris
- Vaughn Jackson syndrome
- General
Evaluation
Types
- Simple: subluxation
- Joint appears hyperextended to 60-90 deg
- Complex: dislocation
- MCP joint is in moderate hyperextension with metacarpal head prominent in palm
- Volar plate is interposed in MCP joint space
- X-ray may show seasamoid within joint space (pathognomonic)
- Closed reduction is not possible
Management
Reduction
- Traction alone may convert simple MCP dislocation may convert it to a complex dislocation [1]
- Dorsal dislocation
- Flex the wrist to relax the flexor tendon
- Hyperextend the joint
- Apply pressure over dorsum of proximal phalanx in distal and volar direction
- Volar dislocation
- Rare, will likely need open reduction
- If attempting closed reduction, push finger into the MCP joint and then hyperflex joint
- After hyperflexing, pull traction and extend finger, using thumbs to guide proximal finger into place [2]
Splinting
- Splint with MCP joint in flexion
- Refer to hand surgeon within 2 weeks
Disposition
- Outpatient management
See Also
External Links
References
- ↑ Horn A. Management of Common Dislocations. In: Roberts and Hedges' Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Elsevier; 2014.
- ↑ Davenport M. Procedures for orthopedic emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.