Entrapment of the Metacarpophalangeal Joint of the Middle Finger

Abstract

Locking of the second metacarpal joint is common, but locking of other metacarpal joints is unusual. We present a case, in which the joint of the third finger locked and the mechanism was an osteophyte catching of the ulnar accessory collateral ligament. In such a case, the joint should be explored through a palmar approach. Conservative treatment is not recommended.

Locking of the Proximal Interphalangeal Joint of the Little Finger

“…Furthermore, a locked trigger digit may release on gentle traction of the digit, whereas the locked proximal interphalangeal joint will not. The pathology found in our case is similar to that seen in a locked metacarpophalangeal joint, in which the ulnar collateral ligament or palmar plate becomes trapped behind a large osteophyte (Aston, 1960;Goodfellows and Weaver, 1961;Vinnars et al, 1996). Other causes of locked metacarpophalangeal joint include entrapment of the first dorsal interosseous tendon on an exostosis of the metacarpal head (Charendoff, 1979), a tear in the palmar plate with impingement upon a large articular eminence of metacarpal head (Yancey and Howard, 1962), incongruence of the joint as a result of degeneration of the articular surface (Harvey, 1971;Flatt, 1961;Dibbel and Field, 1967), abnormal bands and membranes within the joint (Bruner, 1961), a loose body (Honner, 1969) and a trapped sesamoid bone (Bloom and Byran, 1965;Flatt, 1961).…”

Case Report: Osteochondral Fragment—A Rare Cause of Locked Metacarpophalangeal Joint

“…This is commonly confused with triggering of the flexor tendon under the A1 pulley [1]. True locking can occur when the volar plate or collateral ligament catches on an osteophyte [2] or abnormally shaped metacarpal head. Other causes include: entrapment of a sesamoid bone behind an exostosis of the metacarpal head, subluxation of the dorsal interosseous tendon over a dorsal exostosis [3], foreign bodies within the flexor sheath [4], volar plate interposition, volar plate haemangioma [5] or gouty degeneration of the MCP joint.…”

Locking of the Index Finger Metacarpophalangeal Joint Due to a Chronic Osteochondral Fracture Fragment of the Metacarpal Head: A Case Report

“…Although incarceration of the sesamoid in the joint is anatomically impossible [38], Terrill [32], Thomsen [33], Gilligan [13], Desai [9], Tsuge [34], Kojima [23], and Flatt [11] all reported locked thumb MCP joints caused by sesamoid entrapment. A benign chondroma and hemangioma as the causes of locking have also been documented [7,10,37]. Schuind [30] described an intra-articular fracture of the metacarpal head, and Honner [17] described loose bodies within the MCP joint causing locking.…”

“…A locked thumb MCP joint exhibits a mild hyperextension deformity with loss of flexion at the joint [19,25]. Most cases of locking have been related to impingement of normal gliding of the volar plate or the accessory collateral ligament on either an osteophyte or bony prominence on the metacarpal condyle head [2,4,12,22,24], but intraarticular fracture of the metacarpal head [30], sesamoid entrapment [4,5,9,13,18,23,[32][33][34][35], first dorsal interosseous muscle [8], loose bodies [17], and chondroma [7,37] have also been reported.…”