Causes of Locking Metacarpophalangeal Joint of the Thumb and Its Non-Operative Treatment
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Abstract:
The non-operative method of reduction of locking metacarpophalangeal joint of the thumb is described, and illustrated by four case reports. Experimental studies in the hands of a fresh cadaver are also described. Locking of the metacarpophalangeal joint of the thumb can be produced by slight external forces, insufficient to damage strong tissues. Incarceration of the sesamoid bone is anatomically impossible, but incarceration of the proximal portion of the volar plate is believed to be the true cause. This incarceration can be reduced easily by our non-operative method along with intra-articular injection of local anaesthetics.Keywords:
Metacarpophalangeal joint
Sesamoid bone
The non-operative method of reduction of locking metacarpophalangeal joint of the thumb is described, and illustrated by four case reports. Experimental studies in the hands of a fresh cadaver are also described. Locking of the metacarpophalangeal joint of the thumb can be produced by slight external forces, insufficient to damage strong tissues. Incarceration of the sesamoid bone is anatomically impossible, but incarceration of the proximal portion of the volar plate is believed to be the true cause. This incarceration can be reduced easily by our non-operative method along with intra-articular injection of local anaesthetics.
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Sesamoid bone
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CASE:Fracture of a sesamoid bone of the thumb is rare. We report a case of such a fracture after hyperextension of the thumb in a 26-year-old woman. After a volar plate injury was excluded, she was treated nonoperatively with 5 weeks of immobilization followed by physical therapy. CONCLUSION:After reviewing the current literature describing sesamoid fractures of the thumb, we recommend that fracture of the sesamoid of the metacarpophalangeal (MCP) joint should be regarded as an avulsion fracture. The role of surgical intervention should be limited to patients with a painful nonunion.
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Case: Fracture of a sesamoid bone of the thumb is rare. We report a case of such a fracture after hyperextension of the thumb in a 26-year-old woman. After a volar plate injury was excluded, she was treated nonoperatively with 5 weeks of immobilization followed by physical therapy. Conclusion: After reviewing the current literature describing sesamoid fractures of the thumb, we recommend that fracture of the sesamoid of the metacarpophalangeal (MCP) joint should be regarded as an avulsion fracture. The role of surgical intervention should be limited to patients with a painful nonunion.
Sesamoid bone
Avulsion fracture
Metacarpophalangeal joint
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Metacarpophalangeal joint
Sesamoid bone
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Fracture of thumb sesamoids is a rare injury. We are reporting four cases. In two cases, the fracture involved the ulnar sesamoid and in two others, the radial sesamoid. The right thumb was affected in two patients and the left thumb in the other two. In one patient, arthrography of the metacarpophalangeal joint of the thumb demonstrated contrast leakage from the volar aspect of the joint and confirmed volar plate rupture. All patients were treated conservatively with immobilization. Normal hand function was restored in all four patients. Sesamoid fractures may accompany severe injuries of the fibrous plate. Radiologists and orthopaedists should be aware of the possibility of this fracture in injuries of the thumb. Early recognition of the fracture leads to appropriate treatment and avoids possible instability of the metacarpophalangeal joint.
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