Operative mobilization of stiff metacarpophalangeal joints: dorsal versus volar approach

The effectiveness and merits of the dorsal and volar approaches for release of structures contributing to metacarpophalangeal joint stiffness were studied in 61 joints in 23 patients. Seventy-six percent of the joints in the volar group gained greater than 50 degrees passive motion compared to 29% in the dorsal group. Forty-four percent of the joints in the volar group gained greater than 50 degrees active motion compared to 16% in the dorsal group. Discussion of surgical technique and postoperative management reveals that the advantages of the volar approach are most evident during postoperative management, while the main advantage of the dorsal approach is better operative exposure.