Locked metacarpophalangeal joint of long fingers: Clinical presentation, literature review, and a treatment-oriented classification

Abstract

Objectives: The purpose of this article was to present two exemplary cases of the disorder known as locked metacarpophalangeal(MCP) joint of long fingers, to review the literature and to recommend the possible surgical approachesbased on the involved anatomic structures.Patients and Results: We recently took care of two patients with locked MCP joint representing the two main etiologies ofthis disorder. After clinical and imaging investigations both patients were operated. The first patient had a locked intra-articularloose body in the third metacarpophalangeal joint, which was undetectable on MRI. The second had a locking of theaccessory collateral ligament behind a radial sided prominence of the second metacarpal head. Both had a satisfactoryoutcome after surgery.Conclusion: Left untreated, the locked MCP joint may lead to a flexion contracture. The diagnosis is mainly clinical. Theradiographs can show degenerative changes or a particular shape of the metacarpal head/neck as a first clue to the possiblecause. A MRI may help to precise the origin of the locking. Gentle closed reduction can be attempted, but surgery ismost often required. The surgical approach depends on the presumed localization of the pathology.