Metacarpophalangeal Joint Arthritis (2022)

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The Journal of Hand Surgery

Volume 36, Issue 2,

February 2011

, Pages 345-353

Arthritis of the metacarpophalangeal joint can result in considerable disability and pain. Inflammatory, posttraumatic, crystalline, and osteoarthritis are common etiologies of joint disease. A variety of nonsurgical treatment options have been shown to be effective, including activity modification, anti-inflammatory medications, splinting, and cortisone injections. In addition, newer generation disease-modifying antirheumatic drugs geared toward the treatment of rheumatoid arthritis have shown promise in retarding the inflammatory process. Another, relatively newer, conservative treatment option includes topical anti-inflammatories such as diclofenac sodium that are now approved by the Federal Drug Administration. Surgical treatment options most commonly include arthroplasty and arthrodesis. In the treatment of thumb metacarpophalangeal arthritis, arthrodesis is a popular and generally reliable surgical solution. In the fingers, arthroplasty remains the most common treatment option. Traditional constrained silicone joint replacements remain the most commonly used. Newer generation, unconstrained, surface replacement arthroplasties have shown promise in the treatment of osteoarthritis and select cases of inflammatory arthritis in which there is good bone stock, no or minimal deformity, adequate supporting soft tissues, and good disease control.

Section snippets

Clinical and Radiographic Evaluation

Patients with MCP arthritis typically present with pain, swelling, and limited motion of the MCP joint. Persons affected with rheumatoid arthritis (RA) will frequently have varying degrees of deformity. Typically, the fingers will deviate in an ulnar direction, and this deformity can also be driven by more proximal malalignment, such as radial deviation of the wrist. As the inflammatory disease progresses, the proximal phalanx will subluxate in a volar direction on the metacarpal head. The

Nonsurgical Treatment

Conservative treatment options for the management of osteoarthritis and inflammatory arthritis primarily include splinting, pharmacologic medications, and corticosteroid injections. There have been notable developments in the evolution of some of the pharmacologic treatments for RA over the past decade. Traditional disease-modifying antirheumatic drugs (DMARDs) such as oral corticosteroids, methotrexate, azathioprine, sulfasalazine, and leflunomide have been used for many years. A usual

Considerations Regarding Surgery

Surgery for MCP arthritis is an option for patients who have failed conservative measures. Persistent symptoms, synovitis, or swelling despite a 3- to 6-month course of nonsurgical interventions is viewed by most surgeons as an appropriate indication for surgery. Considerations for surgery, especially in patients with RA, require a thoughtful assessment of multiple factors such as nutritional status, comorbidities, pharmacologic disease control, infection risk, and the presence of cervical

(Video) Osteoarthritis of carpometacarpal Thumb joint

Surgery for the Thumb Metacarpophalangeal Joint

Surgical treatment of thumb MCP arthritis is less common than that of the trapezial-metacarpal joint. The most common surgical treatment of the arthritis thumb MCP joint remains arthrodesis. Most of the mobility of the thumb arises from the carpometacarpal joint; therefore, MCP arthrodesis is generally well tolerated. The optimal position of arthrodesis is typically 5° to 15° of flexion. It is important to examine and assess the carpometacarpal and interphalangeal joints for arthritis and range

Surgery for the Finger Metacarpophalangeal Joints

Arthroplasty is favored over arthrodesis for arthritis of the index through small finger MCP joints. Preserving some degree of flexion-extension and abduction-adduction of the digits not only helps function but also allows for better hygiene. However, MCP joint arthrodesis can reliably relieve pain. The etiology and activity of disease are important considerations in deciding the optimal arthroplasty treatment. Hinged silicone implants and newer-generation unconstrained surface replacement

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  • Cited by (41)

    • Management of the Metacarpophalangeal and Scaphotrapeziotrapezoidal Joints in Patients with Thumb Trapeziometacarpal Arthrosis

      2022, Hand Clinics

      (Video) Treating Basal Thumb Joint Arthritis - Mayo Clinic
    • Arthrodesis and Arthroplasty of the Small Joints

      2020, Operative Techniques in Orthopaedics

      Arthritis of the small joints of the hand is a common problem encountered by orthopaedic hand surgeons. Nonoperative management is maximized to include splinting, injections, therapy in some situations, and oral analgesics. Pain is the main indication for joint arthroplasty and arthrodesis of the small joints of the hand. Additional indications include deformity, stiffness, and joint incongruity as seen in degenerative and inflammatory arthritis. We describe specific indications for treatment of the metacarpal phalangeal, finger proximal and distal interphalangeal, and thumb interphalangeal joints. Treatment options include open debridement of painful osteophytes, arthroplasty, and arthrodesis. Bone and soft-tissue stability is necessary to support an implant, thus treatment is dependent on the soft-tissue envelope and the amount of joint destruction. Based on the literature and the authors’ experience, arthrodesis is a better alternative than arthroplasty in most cases.

    • Joint Fusion and Arthroplasty in the Hand

      2019, Clinics in Plastic Surgery

      Unconstrained surface replacement arthroplasty for the MCP joint is indicated for patients with good bone stock and fewer deformities. Osteoarthritis rather than RA of the MCP joint can be a candidate for surface replacement arthroplasty.31 The PyroCarbon implant has an iso-elasticity to cortical bone with higher durability and biocompatibility.

    • Biomechanical analysis of metacarpophalangeal joint arthroplasty with metal-polyethylene implant: An in-vitro study

      2019, Clinical Biomechanics

      The most common implant options for the metacarpophalangeal joint arthroplasty include silicone, pyrocarbon and metal-polyethylene. A systematic review of outcomes of silicone and pyrocarbon implants was conducted; however, a similar exercise for metal-polyethylene implants revealed a scarcity of published results and lack of long-term follow-up studies. The aim of the present work is to test the hypothesis that the magnitude of metacarpophalangeal joint cyclic loads generates stress and strain behaviour, which leads to long-term reduced risk of metal-polyethylene component loosening.

      This study was performed using synthetic metacarpals and proximal phalanges to experimentally predict the cortex strain behaviour for both intact and implanted states. Finite element models were developed to assess the structural behaviour of cancellous-bone and metal-polyethylene components; these models were validated by comparing cortex strains predictions against the measurements.

      Cortex strains in the implanted metacarpophalangeal joint presented a significant reduction in relation to the intact joint; the exception was the dorsal side of the phalanx, which presents a significant strain increase. Cancellous-bone at proximal dorsal region of phalanx reveals a three to fourfold strain increase as compared to the intact condition.

      Interpretation

      The use of metal-polyethylene implant changes the strain behaviour of the metacarpophalangeal joint yielding the risk of cancellous-bone fatigue failure due to overload in proximal phalanx; this risk is more important than the risk of bone-resorption due to the strain-shielding effect. By limiting the loads magnitude over the joint after arthroplasty, it may contribute to the prevention of implant loosening.

    • Outcomes Following Acute Metacarpophalangeal Joint Arthroplasty Dislocation: An Analysis of 37 Cases

      2018, Journal of Hand Surgery

      There remains a paucity of information regarding the treatment outcomes of dislocation after metacarpophalangeal (MCP) joint arthroplasty. The purpose of this study was to assess the outcomes of surgical and nonsurgical treatment modalities of MCP arthroplasty dislocations.

      Of 816 MCP joint arthroplasties over a 14-year period, there were 37 (4%) acute MCP joint dislocations that required intervention by a health care professional. Implants involved included 28 nonconstrained implants including pyrocarbon (n= 17) and surface replacement arthroplasty (n= 11), and 9 silicone implants. The analysis included the treatment of dislocations after primary (n= 30) and revision (n= 7) MCP joint arthroplasty. Dislocation was defined as clinical and radiographic evidence of MCP joint prosthetic acute dislocation diagnosed and treated by a fellowship trained hand surgeon.

      Etiologies underlying the dislocations included implant fracture (n= 6), component loosening (n= 2), and soft tissue deficiency (n= 29). Of the 37 dislocations, treatments included 14 nonsurgical (closed reduction, orthosis fabrication) all of which ultimately failed. Surgically, including some of the failed prior procedures, 18 soft tissue stabilization procedures and 21 revision arthroplasties were performed, with 6 that had failed soft tissue stabilization. The soft tissue stabilization procedures had a 28% success rate in achieving a stable MCP joint. Revision arthroplasty had a 71% success rate. Subgroup analysis showed an 86% success rate for silicone revisions and a 43% success rate with nonconstrained revisions, with 80% and 36% 5-year survival free of instability, for the 2 types of implants, respectively.

      The treatment of MCP joint arthroplasty dislocation with revision to silicone implant appears to hold the most promise in achieving a stable MCP joint after an acute prosthetic dislocation.

      Therapeutic IV.

    • Nonrheumatoid Arthritis of the Hand

      2018, Journal of Hand Surgery

      (Video) Chiropractic Extremity Adjustment Thumb Metacarpophalangeal MCP Joint

      Arthralgia is treated by placement of an orthosis, analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs), or corticosteroid injections. If nonoperative treatments are ineffective, arthroscopy, arthroplasty, and arthrodesis are options for treatment.12 In the case of unexplained isolated MCP arthritis involving the index or middle finger, hemochromatosis should be considered.

      Arthropathy of the hand is commonly encountered. Contributing factors such as aging, trauma, and systemic illness all may have a role in the evolution of this pathology. Besides rheumatoid arthritis, other diseases affect the small joints of the hand. A review of nonrheumatoid handarthropathies is beneficial for clinicians to recognize these problems.

    View all citing articles on Scopus

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    Copyright © 2011 Published by Elsevier Inc.

    (Video) Ultrasound guided metacarpophalangeal(MCP) joint injection in a patient with rheumatoid arthritis

    FAQs

    How do you treat metacarpophalangeal joints? ›

    How is Metacarpophalangeal (MCP) Joint Arthritis Treated?
    1. Activity modification or hand therapy.
    2. Anti-inflammatory medications (oral or steroid injections)
    3. Cortisone injections (if medication fails)
    4. Simple splinting or flexible strapping.
    5. Topical skin creams.

    What disease most commonly affects the MCP joint? ›

    Causes. The MCP joint can be affected by arthritis from many different causes. They include but are not limited to: Osteoarthritis, which is routine wear and tear.

    How do I stop my fingers from deforming with arthritis? ›

    Ring splints can be worn on any of the fingers to help these problems and other deformities, such as joints that become “stuck” in a hyperextended position or instability at the knuckles, which lets fingers cross under or over each other.

    How do you stop arthritis from progressing in your hands? ›

    A complete treatment plan for arthritis of the hand includes these additional approaches:
    1. Exercises — strengthening and stretching — to reduce symptoms and improve function. ...
    2. Hot and cold packs. ...
    3. Rest. ...
    4. Healthy eating and managing diabetes and cholesterol.
    5. Weight loss if you're overweight.
    6. Smoking cessation.
    Jul 6, 2021

    What is MCP arthritis? ›

    What is metacarpophalangeal joint (MCP) arthritis? It is arthritis of the knuckles, usually the knuckles of the thumb and index finger. The metacarpal bones are the bones of the hand. The finger bones are called phalanges.

    What is metacarpal arthritis? ›

    Carpo-metacarpal (CMC) osteoarthritis, also known as trapezio-metacarpal osteoarthritis or osteoarthritis at the base of the thumb is a reparative joint disease affecting the first carpo-metacarpal joint [3]. This joint is formed by the trapezium bone of the wrist and the first metacarpal bone of the thumb.

    What arthritis affects MCP joints? ›

    Causes of Metacarpophalangeal Joint Arthritis

    Rheumatoid arthritis is the most common arthritic condition affecting the MP joints. When this condition develops, the joint lining (synovium) produces chemical factors that inflame and destroy the cartilage and soft tissue, such as ligaments and tendons.

    Can MCP joint be replaced? ›

    Metacarpophalangeal joint arthroplasty is a procedure performed to treat rheumatoid arthritis of the MCP joints. Also known as joint replacement, arthroplasty involves removing the damaged joints and tissue, and replacing them with synthetic materials or artificial implants.

    Can you be tested for arthritis? ›

    Laboratory tests

    The analysis of different types of body fluids can help pinpoint the type of arthritis you may have. Fluids commonly analyzed include blood, urine and joint fluid. To obtain a sample of joint fluid, doctors cleanse and numb the area before inserting a needle in the joint space to withdraw some fluid.

    Which vitamins help arthritis? ›

    Several nutritional supplements have shown promise for relieving pain, stiffness and other arthritis symptoms. Glucosamine and chondroitin, omega-3 fatty acids, SAM-e and curcumin are just some of the natural products researchers have studied for osteoarthritis (OA) and rheumatoid arthritis (RA).

    What type of arthritis causes crooked fingers? ›

    Rheumatoid Arthritis
    • Figure 1. The joints affected by rheumatoid arthritis.
    • Fingers drifting away from the thumb is a unique sign of rheumatoid arthritis.
    • A Boutonniere deformity is a bent middle finger joint. A swan-neck deformity is a bent end of the finger and over-extended middle joint.

    What kind of arthritis causes bumps on fingers? ›

    If you have Heberden's nodes, which are a sign of advanced osteoarthritis, you may have symptoms such as: Pain, swelling and stiffness. Bumps at the ends of your fingers.

    Is drinking more water good for arthritis? ›

    Staying hydrated is vital when you live with arthritis. Hydration is key for flushing toxins out of your body, which can help fight inflammation, and well-hydrated cartilage reduces the rate of friction between bones, meaning you can move more easily.

    Are bananas good for arthritis? ›

    Bananas and Plantains are high in magnesium and potassium that can increase bone density. Magnesium may also alleviate arthritis symptoms.

    Do hand massagers work for arthritis? ›

    Hand massage can complement treatments for arthritis, carpal tunnel syndrome, neuropathy, and other conditions. A professional hand massage is a good investment for your overall health. And a daily self-massage routine can provide you with ongoing benefits.

    What is another name for metacarpophalangeal joint? ›

    The metacarpophalangeal (MCP) joints are located where the hand's fingers and thumb meet the palm. They are commonly known as large knuckles. In medical terminology, the MCP joints are synovial joints located between the metacarpals and proximal phalanges.

    How do you tape a metacarpophalangeal joint? ›

    Thumb Sprain Taping for MCP joint - YouTube

    What causes metacarpal pain? ›

    The region of the index finger metacarpophalangeal (MCP) joint is a common source of hand pain with variable etiology. Known causes of pain at this site include stenosing tenosynovitis, ganglion, osteoarthritis, fracture, dislocation, ligament injury, infection, and inflammatory arthropathy.

    How do they test for arthritis in hands? ›

    A doctor can diagnose arthritis of the hand by examining the hand and by taking x-rays.

    At what age does arthritis usually start? ›

    It most commonly starts among people between the ages of 40 and 60. It's more common in women than men. There are drugs that can slow down an over-active immune system and therefore reduce the pain and swelling in joints.

    What is the main cause of arthritis? ›

    Arthritis is caused by inflammation of the joints. Osteoarthritis usually comes with age and most often affects the fingers, knees, and hips. Sometimes osteoarthritis follows a joint injury. For example, you might have badly injured your knee when young and develop arthritis in your knee joint years later.

    Does RA affect metacarpophalangeal joint? ›

    Rheumatoid arthritis (RA) is a chronic inflammatory disease caused by a T cell-driven autoimmune process, which majorly involves the diarthrodial joints. It affects 1% of the US population, and approximately 70% of patients with RA develop pathologies of the hand, especially of the metacarpophalangeal joints (MCP).

    Is arthritis an autoimmune disease? ›

    Inflammatory arthritis is a chronic autoimmune disease in which your immune system misidentifies your own body tissues as harmful germs or pathogens and attacks them. The result is inflammation of the affected tissues in and around joints.

    How long does MCP joint replacement last? ›

    A retrospective study of patients who underwent metacarpophalangeal joint replacement with silastic implants and were followed up to 17 years found a 63% success rate with the procedure. Two-thirds of the implants fractured by 15 years' postop.

    How long does it take to recover from finger joint replacement? ›

    Within about eight to 10 weeks, the majority of patients regain, on average, about two-thirds of the finger's normal range of motion. By that point, patients are able to resume their usual activities.

    What is arthroplasty in surgery? ›

    Arthroplasty is a surgical procedure to restore the function of a joint. A joint can be restored by resurfacing the bones. An artificial joint (called a prosthesis) may also be used.

    What is the most painful type of arthritis? ›

    Rheumatoid arthritis can be one of the most painful types of arthritis; it affects joints as well as other surrounding tissues, including organs. This inflammatory, autoimmune disease attacks healthy cells by mistake, causing painful swelling in the joints, like hands, wrists and knees.

    Does arthritis hurt all the time? ›

    Pain. Pain from arthritis can be constant or it may come and go. It may occur when at rest or while moving. Pain may be in one part of the body or in many different parts.

    Does arthritis show up on xrays? ›

    X-Ray. X-rays give a two-dimensional picture of your joints. They show joint space narrowing (a sign of arthritis), erosions, fractures, lower-than normal bone density and bone spurs.

    How do you fix a dislocated metacarpophalangeal joint? ›

    The suggested reduction technique for a simple MCP joint dislocation is flexion at the wrist and proximal interphalangeal joint to relax flexor tendons while pressure is applied to the proximal phalanx at the base.

    Why does my MTP joint hurt? ›

    Metatarsophalangeal joint pain most commonly results from misalignment of the joint surfaces with altered foot biomechanics, causing joint subluxations, flexor plate tears, capsular impingement, and joint cartilage destruction (osteoarthrosis).

    Where is the metacarpophalangeal joint located? ›

    The metacarpophalangeal joints (MCP) are a collection of condyloid joints that connect the metacarpus, or palm of the hand, to the fingers. There are five separate metacarpophalangeal joints that connect each metacarpal bone to the corresponding proximal phalanx of each finger.

    How do you inject a MCP joint? ›

    For arthrocentesis of the metacarpophalangeal joint, insert a 25-gauge needle at either side of the extensor tendon from above or at a 90° angle from above, while gentle traction is applied to the finger.

    Can you dislocate a metacarpal? ›

    The trapezoid metacarpal dislocation is a rare event. In the literature, it is found in case reports. This injury is caused by direct or indirect high energy trauma. In most cases, the dislocation is dorsal and is difficult to reproduce because the joint is not very mobile.

    What is Bennett's fracture? ›

    Bennett fracture is the most common fracture involving the base of the thumb. This fracture refers to an intraarticular fracture that separates the palmar ulnar aspect of the first metacarpal base from the remaining first metacarpal.

    How many degrees the metacarpophalangeal joints Hyperextend? ›

    Many suggest that MCP hyperextension of <10 degrees can be left alone, whereas those between 10 and 20 degrees can be treated with temporary MCP joint pinning or alternatively with transfer of the EPB to lessen its deforming force.

    What is first MTP osteoarthritis? ›

    Osteoarthritis is wear and tear of the cartilage inside a joint and in the foot commonly affects affects the big toe joint known as the first metatarso-phalangeal or MTP joint. Extra bone called osteophytes form around the joint and this is sometimes referred to as a dorsal bunion.

    What is degenerative changes first MTP joint? ›

    Hallux limitus/rigidus is defined as a degenerative arthrosis of the first metatarsophalangeal joint (MTPJ) which is characterized by a decrease in the MTPJ range of motion and an eventual lack of motion. 1 Treatment for this condition is a frequently discussed topic at podiatric conferences.

    What is arthritis caused from? ›

    Arthritis is caused by inflammation of the joints. Osteoarthritis usually comes with age and most often affects the fingers, knees, and hips. Sometimes osteoarthritis follows a joint injury. For example, you might have badly injured your knee when young and develop arthritis in your knee joint years later.

    What arthritis affects MCP joints? ›

    Causes of Metacarpophalangeal Joint Arthritis

    Rheumatoid arthritis is the most common arthritic condition affecting the MP joints. When this condition develops, the joint lining (synovium) produces chemical factors that inflame and destroy the cartilage and soft tissue, such as ligaments and tendons.

    What muscles flex the metacarpophalangeal joints? ›

    The flexors are the flexor pollicis brevis, lumbricals, interossei, and flexor digiti minimi brevis, assisted by the long flexors. Radial and ulnar movements at the second to fifth MCP joints are a function of the intrinsic muscles.

    Does the thumb have an MCP joint? ›

    Metacarpophalangeal Joint (MP)

    The MP joint primarily allows you to bend and extend the thumb. The ulnar collateral ligament of the thumb MP joint is important to stabilize the thumb during most pinch activities and is commonly injured.

    What is the best injection for arthritis? ›

    Studies show hyaluronic acid injections may work better than painkillers for some people with OA. Other studies have shown they also may work as well as corticosteroid knee injections. Hyaluronic acid injections seem to work better in some people than others.

    Can you have injections for arthritis in fingers? ›

    Anesthetic injections can be used for pain in any joint of the hand, says Dr. Wolf. These may be administered alone, but often they are injected along with a corticosteroid to provide immediate pain relief while waiting for the corticosteroid to take effect. Their most common use may be for diagnosis, says Dr.

    Can cortisone help arthritis in fingers? ›

    A cortisone shot can be used to treat some problems in the arm and hand. These can include trigger fingers, tendonitis, carpal tunnel syndrome, arthritis, tennis elbow and rotator cuff tendonitis. These injections usually contain a numbing medicine.

    Videos

    1. CS: Arthritic Hand- MCP & PIP Pathology
    (Sonosite)
    2. MCP and IP joint mobilizations
    (Joint Mobilizations)
    3. Thumb - Destroyed Metacarpophalangeal Joint - Arthrodesis of the Joint, and Fixation
    (Pathognomonique)
    4. Thumb MCP joint extension mobility L
    (Online Physio Expert)
    5. Thumb Carpometacarpal (CMC) Joint Arthritis Treatment
    (The Center Orthopedic & Neurosurgical Care)
    6. MCP - Metacarpophalangeal joints
    (Husky Orthopaedics)

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