J Korean Soc Surg Hand.  2016 Jun;21(2):63-69. 10.12790/jkssh.2016.21.2.63.

The Role of Arthroscopy of Acute and Chronic Painful Thumb Metacarpophalangeal Joint

• Kim KC
• Shin YE
• Kim JP

• KMID: 2328389
• DOI: http://doi.org/10.12790/jkssh.2016.21.2.63

Abstract

PURPOSE
There has been few published on arthroscopy of metacarpophalangeal joint (MCPJ) despite increasingly being used worldwide. The purpose of this study was to investigate the effectiveness of arthroscopy for pathologies around MCPJ of the thumb.
METHODS
Between September 2007 and June 2015, 56 patients (56 thumb) who underwent arthroscopy of the MCPJ were retrospectively studied. Preoperative diagnoses, which were made through physical examination, plain radiograph, stress radiography, ultrasound, and magnetic resonance images (MRI), were compared with arthroscopic findings. Therapeutic arthroscopic surgeries were performed according to the needs of each patient. Functional outcomes were assessed with physical examination as well as disabilities of the arm, shoulder and hand (DASH) score and Michigan Hand outcomes Questionnaire (MHQ) score at an average 7.3 months follow-up.
RESULTS
Six patients who suspected with collateral ligament injuries in MRI confirmed different diagnoses under arthroscopy. At final follow-up, the mean range of flexion contracture of the MCPJ was 5°, and the mean range of further flexion was 52.7°. Grip and pinch strength averaged 87.2% and 79.3% of contralateral side. Mean DASH and MHQ score were improved from 48.1 and 44.6, preoperatively to 14.9 and 26.3, postoperatively (p<0.001, p=0.012, respectively). All patients were satisfied with their outcomes at final follow-up, except 4 patients who noted joint stiffness or chronic pain around the thumb.
CONCLUSION
Our results revealed that arthroscopy is helpful for both diagnostic and therapeutic purposes of acute and chronic painful MCPJ of the thumb. However, further studies are needed to expand the applications of arthroscopy of MCPJ of the thumb.

Keyword

Metacarpophalangeal joint; Collateral ligament injury; Volar plate injury; Arthroscopy

MeSH Terms

Arm
Arthroscopy*
Chronic Pain*
Collateral Ligaments
Contracture
Diagnosis
Follow-Up Studies
Hand
Hand Strength
Humans
Joints
Magnetic Resonance Imaging
Metacarpophalangeal Joint*
Michigan
Pathology
Physical Examination
Pinch Strength
Radiography
Retrospective Studies
Shoulder
Thumb*
Ultrasonography

Figure

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  Fig. 1. Arthroscopic portals of the metacarpophalangeal joint of the thumb. MCP, metacarpophalangeal joint; EPL, extensor pollicis longus; EPB, extensor pollicis brevis.

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  Fig. 2. (A) Arthroscopic finding of UCL rupture (arrow). (B) Magnetic resonance images finding of UCL rupture (dotted line arrow). UCL, ulnar collateral ligament.

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  Fig. 3. (A) Arhtroscopic finding of Stener lesion (arrow). (B) Magnetic resonance images finding of Stener lesion (dotted line arrow).

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  Fig. 4. (A) Preoperative X-ray of avulsion fracture of first proximal phalanx. (B) Arthroscopic finding of avulsion fracture of first proximal phalanx. (C) After arthroscopic reduction. (D) Postoperative X-ray after arthroscopic reduction and percutaneous pinning.

• 

  Fig. 5. Arthroscopic finding of sesamoid fracture.

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