Degenerative diseases of the metacarpophalangeal joints
1Hand Surgery Service, St. Elizabeth's Hospital of Boston, Massachusetts.
Abstract:
Degenerative arthritis of the finger metacarpophalangeal joints is uncommon and, when seen, a specific etiology should be sought. MP joint arthritis in the absence of a history of trauma may signal an underlying systemic disease. The clinical and radiographic findings may be subtle. Once degenerative changes occur, the usual treatment is arthroplasty using a flexible silicone rubber (Swanson) finger joint implant that should provide a relatively stable and painless joint with a functional range of motion. Degenerative arthritis of the thumb MP joint is more common following injuries that damage the ligaments on the ulnar or radial side of the MP joint and which result in lateral instability of the joint. Arthritis of the MP joint also may occur following infection or direct joint injury. Secondary MP arthritis may result from thumb CMC joint disease and must be attended to at the time CMC joint reconstruction is performed. Degenerative disease of the thumb sesamoid bones must be considered in patients with persistent MP joint pain after either trauma or MP joint fusion.
Insights
Metacarpophalangeal (MP) joint arthritis is rare in fingers but common in thumbs after injury. Treatment often involves joint replacement with silicone implants for stability and function.
Area of Science:
- Orthopedics
- Rheumatology
- Hand Surgery
Background:
- Degenerative arthritis affecting finger metacarpophalangeal (MP) joints is uncommon.
- When observed, it necessitates seeking a specific underlying etiology, as it may indicate systemic disease.
- Clinical and radiographic findings can be subtle.
Purpose of the Study:
- To review the etiology, clinical presentation, and treatment of degenerative arthritis of the finger and thumb MP joints.
- To highlight the importance of identifying underlying causes beyond trauma for finger MP joint arthritis.
- To discuss management strategies, including arthroplasty with silicone implants.
Main Methods:
- Literature review of degenerative arthritis affecting MP joints.
- Analysis of clinical and radiographic presentations.
- Discussion of treatment modalities, focusing on arthroplasty.
Main Results:
- Finger MP joint arthritis, without trauma history, suggests systemic disease.
- Thumb MP joint arthritis frequently follows ligamentous injury, leading to instability.
- Secondary MP arthritis can arise from carpometacarpal (CMC) joint disease or sesamoid bone issues.
Conclusions:
- Arthroplasty with silicone implants is a common treatment for degenerative finger MP joint arthritis, aiming for stability and function.
- Thumb MP joint arthritis requires addressing ligamentous integrity and potential secondary causes like CMC joint disease.
- Persistent MP joint pain post-trauma or fusion may involve sesamoid bone pathology.
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