Metacarpophalangeal Dislocations

Metacarpophalangeal Dislocations

Joseph A. Rosenbaum

Hisham M. Awan


  • Pathoanatomy

    • Dislocation of the metacarpophalangeal (MCP) joint secondary to trauma

    • Force applied to the MCP joint exceeds the strength of its capsuloligamentous support.

  • Mechanism of injury

    • Mechanisms of injury include torsional, angular, and tractional forces across joint.

    • Dorsal dislocations may be caused by forced hyperextension.

    • Dislocation may be part of a more severe overall injury pattern including soft tissue injury to ligament, tendon, nerve, and/or vessels.

  • Epidemiology/background

    • Dislocations of MCP joints are not very common.

    • Often seen in laborers or athletes

    • Males are affected more than females.


  • History

    • Typically caused by trauma, either direct or indirect

    • Presentation is usually acute due to deformity and pain.

    • May be overlooked initially in polytrauma cases

  • Physical examination

    • Digit may be held in extension at the MCP with flexion at proximal interphalangeal and distal interphalangeal.

    • Palmar skin puckering indicates a complex dislocation.

    • Assess for edema, angular deformity, rotational deformity, and quality of soft tissues.

    • Identify any lacerations, and rule out open dislocation.

    • Assess sensation and capillary refill distally.

    • Assess the other digits as well as the hand and wrist.

  • Imaging/assessment

    • Obtain hand radiograph if MCP joint dislocation is suspected.

    • Brewerton view may help to identify fractures or joint dislocation.

    • Identify any fractures if present.

  • Classification

    • As with other dislocations, the nomenclature of direction of dislocation is based on which way the distal bone dislocates relative to the proximal bone.

    • Dorsal dislocations—P1 is dislocated dorsally relative to the metacarpal head.

    • Volar dislocations (uncommon)—The proximal phalanx (P1) is dislocated volarly relative to the metacarpal head.


May 7, 2019 | Posted by in ORTHOPEDIC | Comments Off on Metacarpophalangeal Dislocations
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