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Metacarpophalangeal dislocation (finger)
From WikEM
Contents
Background
- Also known as the MCP joint
- Usually forces that rupture volar plate cause dorsal dislocation
Clinical Features
- Mechanism: hyperextension
- Finger pain/deformity
Differential Diagnosis
Hand and finger dislocations
- Finger dislocations
- Distal interphalangeal dislocation (finger) (DIP)
- Proximal interphalangeal dislocation (finger) (PIP)
- Metacarpophalangeal dislocation (finger) (MCP)
- Thumb dislocations
- Hand dislocations
Hand and finger injuries
- Radiograph positive
- Radiograph negative
- Dupeytren contracture
- Boutonniere deformity
- Hand and finger tendon injuries
- Ganglion cyst
- De Quervain tenosynovitis
- Intersection syndrome
- Drummer's wrist
- Extensor digitorum tenosynovitis
- Vaughn Jackson syndrome
- Snapping Extensor Carpi Ulnaris
- Compressive neuropathy, "bracelet syndrome"
- Scaphoid fracture
- Osteoarthritis
- Infiltrative tenosynovitis
- Gout
- Rheumatoid arthritis
- Trigger finger
- Mallet finger
- Jersey finger
- Jammed finger
- Subungual hematoma
- Fingertip laceration
- Metacarpophalangeal (MCP) ulnar ligament rupture (Gamekeeper's thumb)
- Nail avulsion
- High-pressure injection injury
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.
