Bilateral Locking of the Metacarpophalangeal Joint

Abstract

Left untreated, the locked MCP joint may lead to a flexion contracture and disabilities in performing daily life activities. The diagnosis is mainly clinical. The radiographs can show degenerative changes or a particular shape of the metacarpal head/neck as a first clue to the possible cause. Gentle closed reduction can be attempted, but surgery is most often required. The surgical approach depends on the presumed localization of the pathology.

Finger Metacarpophalangeal Joint Injuries in Athletes: Evaluation, Diagnosis, Treatment, and Return to Play

“…5 Although closed reduction may be attempted in certain cases (eg, patients in playoffs or at the end of their season), immediate surgical intervention is often recommended given it effectively eliminates the locking and has good outcomes reported in the literature. 23,24 Choice of surgical approach depends on the cause of locking and which finger is involved. Preoperative advanced imaging with CT and/or MRI may be useful for surgical planning depending on the underlying etiology; CT is particularly valuable, for example, in the setting of a causal osteophyte for precise localization and to determine the optimal surgical approach for excision.…”

“…Recent literature has shown good results with recovery of full motion, no instances of recurrence, and minimal pain. 23,25,26…”

“…Spontaneous (vs degenerative) MCP joint locking is more common in younger (<50 years) patients and involves the index finger. 23,24 An underlying prominent metacarpal head and/or absent deep transverse metacarpal ligament can predispose patients to entrapment of the RCL (Figure 6) and/or palmar plate with certain motions (eg, repetitive pinching motion) or minor trauma; in athletes, RCL laxity caused by chronic stress during weight lifting and contact sports may contribute to the risk for locking in these patients as well. Less commonly, patients with a remote history of trauma may have locking caused by intraarticular fractures, loose bodies, or degenerative changes and incongruency of the metacarpal head.…”

“…Less commonly, patients with a remote history of trauma may have locking caused by intraarticular fractures, loose bodies, or degenerative changes and incongruency of the metacarpal head. 23,24…”

“…Less commonly, patients with a remote history of trauma may have locking caused by intraarticular fractures, loose bodies, or degenerative changes and incongruency of the metacarpal head. 23,24 On examination, there is a painful, rigid block to active and passive MCP extension beyond 30 to 40°, whereas flexion remains intact. Free interphalangeal motion is a key distinguishing feature from a locked trigger finger diagnosis.…”