One of the most frequent injuries of the hand is the MCP. Usually high rates amongst the younger population and athletes it is a dislocation or luxation that affects the Metacarpophalangeal joint of the thumb, or the MCP joint as it is also known. The metacarpophalangeal joint of the thumb is responsible primarily for allowing the movements of flexion, extension, abduction, adduction, and circumduction of the thumb.
All of the MCP joints rely on two basic systems for stabilization. The first is composed by the joint capsule itself alongside the palmar ligaments as well as the collateral ligaments of the articulation. The second stabilizing system is primarily composed of the musculature of the finger and hand; it is this second system which provides the majority of the action potential of the joint. When a dislocation injury affects this essential joint the potential for damage to the muscles, ligaments, nerves, and other tissues surrounding the joint becomes clinically significant; therefore, a better understanding of the mechanisms and of the risk factors involved is necessary.
A dislocation or luxation is any injury to the various capsule-ligament contacts of the joints of the human body. These joint surfaces become injured due to a sudden trauma and may be total or partial.
Dislocation injuries are particularly difficult to treat because often it is challenging to differentiate between a dislocated bone and a fractured bone. Both of these injuries are considered medical emergency situations and the first aid recommendations to treat them are the same. The recovery time for the tissues involved in these types of lesions usually hovers around three to six weeks. More often than not, joint dislocation injuries are caused by a sudden and abrupt impact to the joint and often occur after a blow, fall or other types of trauma.
Diagnosing a dislocation injury of any joint surface is a pretty straightforward procedure.
It is usually done by means of a radiological exploration, in both planes, in order to determine the loss of either partial or total contact between them; however, on most occasions, a simple external visual examination will be enough to observe joint deformity and swelling.
DISLOCATIONS OF THE METACARPOPHALANGEAL JOINT OF THE THUMB
There are three types of MCP dislocations of the thumb:
It is a consequence of falling on the anterior or palmar face of the thumb. This type of dislocation injury is characterized by the protuberance of the phalanx behind the metacarpal bone or by the permanent extension of the phalanx, which cannot be folded. Additionally, a bulge can be typically observed on the palmar side of the thumb, formed by the head of the metacarpal bone.
Complete dislocation of the thumb backward
This type of dislocation injury is very similar to the partial variant. It is typically caused by the same causes as the previous one. Symptoms of a complete dislocation include the phalanx of the thumb is located on the dorsal aspect of the metacarpal bone, in such a way that the thumb has two Z-shaped inflections. On the palmar side of the hand, a protuberance is formed by the head of the first metacarpal bone. The thumb retains the natural direction and is located on a plane posterior and parallel to the plane of the metacarpal bone. Typically it shortens its elevation in relation to the metacarpal bone.
Dislocations of the thumb forward
Dislocations of the thumb of this type may be partial or total. Generally, they occur when the dorsal face of the phalanx receives a strong contusion on the palmar side of the hand. Although the symptoms can be variable, there is typically a particular prominence of the head of the metacarpal bone in the posterior face, with the phalanx rising forward a few millimeters. Additionally, the thumb is found locked in a flexed position.
Forward dislocations of the MCP of the thumb joint are typically easier to treat. A complete reduction is typically achieved by the simply extending the thumb, in conjunction with applying pressure on the head of the metacarpal bone and on the extremity of the phalanx.
TREATMENT OF MCP DISLOCATION
Treatment of dislocation injuries can be divided into two distinct categories:
Dislocations that are stable after their reduction immediately regain a range of active motion. Rare unstable dorsal dislocations should be immobilized for a period of up to 3 weeks before mobility exercises can be started. The total duration of immobilization depends directly on the evaluation of joint stability after reduction.
Surgery is typically required for dislocation injuries with delayed presentation of more than 3 weeks or in case of subluxation is present. In these cases, a surgical reduction may be necessary in order to resect scar tissue and induce tension-free healing. Open dislocations require careful debridement to in order to reduce the risk of infection. Possible fixation with a K-wire wire should be based on the evaluation of joint stability, and it is not a requirement in all open dislocations.
During recovery, and also to preemptively reduce the risk of suffering a dislocation injury, several joint health supplements can be taken to alleviate pain and increase the healing rate.
I personally recommend taking a combination of a high-quality, high-potency Glucosamine Sulphate. Glucosamine is a compound that is naturally produced by the body and helps to fortify the growth of healthy joint tissues such as ligaments and tendons. Glucosamine levels typically fall with age, so it is highly beneficial to begin supplementary ingestion of in order to reduce tension and friction within the joints. During recovery from a dislocation injury, glucosamine will significantly speed up the healing process and the regeneration of lost joint tissue.
Glucosamine can be a good natural or in a supplement form and should be further complemented with a product such as Flexi-Aid, which combines protease and serrapeptase with potent proteolytic enzymes such as bromelain and papain, to provide protection against overextension of the joints by increasing regenerative protein synthesis as well as enhancing circulatory irrigation to the joint.
Look for retailers that sell products that are all-natural, with formulas composed of herbal components and natural enzymatic compounds. It is also important to look for products that meet GMP manufacture standards and that come exclusively from FDA registered facilities.
- Marcotte, Anthony L., and Marc A. Trzeciak. “Nonoperative treatment for a double dislocation of the thumb metacarpal: a case report.” Archives of orthopaedic and trauma surgery 128.3 (2008): 281-284.
- Smith, Richard J. “Post-traumatic instability of the metacarpophalangeal joint of the thumb.” The Journal of bone and joint surgery. American volume 59.1 (1977): 14-21.
- Maheshwari, R., H. Sharma, and R. D. D. Duncan. “Metacarpophalangeal joint dislocation of the thumb in children.” The Journal of bone and joint surgery. British volume 89.2 (2007): 227-229.
- Brand, PAUL W., K. C. Cranor, and J. C. Ellis. “Tendon and pulleys at the metacarpophalangeal joint of a finger.” The Journal of bone and joint surgery. American volume 57.6 (1975): 779-784.
- Inoue, Goro, and Yukihisa Tamura. “Dislocation of the extensor tendons over the metacarpophalangeal joints.” Journal of Hand Surgery 21.3 (1996): 464-469.
- Other clinics with help for MCP