Summary Metacarpophalangeal (MCP) Joint arthritis typically presents with pain, swelling, and limited motion. Inflammatory etiology is much more common than osteoarthritis Diagnosis is made with a combination of physical exam and radiographs which may demonstrate ulnar deviation of the digits with possible volar subluxation of the proximal phalanx on the metacarpal head Treatment occurs on a spectrum of non-operative and operative measures including observation, Disease-modifying antirheumatic drugs (DMARDs), silicone or pyrolytic carbon implants, and arthrodesis Epidemiology Incidence Less common than other joints of the hand login to view 1 more bullet Prevalence primarily affects patients with pre-existing inflammatory arthropathies primary osteoarthritis (OA) is rare login to view 2 more bullets post-traumatic arthritis is rare Demographics more likely to occur in the 4th or 5th decade of life login to view 2 more bullets Risk factors basic risk factors login to view 3 more bullets advanced risk factors login to view 1 more bullet Etiology Pathophysiology trauma login to view 1 more bullet rheumatoid and inflammatory arthritides login to view 1 more bullet cell biology login to view 11 more bullets Anatomy Arthrology MCP joint consists of the proximal phalanx and the corresponding metacarpal diarthrodial joint login to view 2 more bullets thumb MCP joint login to view 2 more bullets Ligament volar plate login to view 1 more bullet volar accessory ligament login to view 1 more bullet deep transverse metacarpal ligament login to view 2 more bullets radial and ulnar collateral ligaments login to view 4 more bullets Tendons volar login to view 4 more bullets dorsal login to view 6 more bullets Classification Larsen Radiographic Scale for Grading Joint Involvement in RA Grade 0 no change Grade I slight changes, including periarticular swelling Grade II erosions, with definitive joint-space narrowing Grade III medium destructive changes with erosions and joint spaces poorly defined Grade IV severe destructive changes and collapse with significant erosions Grade V mutilating changes, original articulating surfaces have disappeared, and there is gross bony deformation Presentation History prior trauma past medical history of rheumatic disease or inflammatory arthritides Symptoms common symptoms of OA login to view 2 more bullets common symptoms of inflammatory arthritis login to view 3 more bullets Physical exam inspection login to view 18 more bullets Imaging Radiographs recommended views login to view 1 more bullet findings login to view 18 more bullets Studies Labs RA login to view 2 more bullets SLE login to view 1 more bullet hemochromatosis login to view 1 more bullet Invasive studies synovial aspiration login to view 9 more bullets Diagnosis confirmed by history, physical exam and radiographs Treatment Nonoperative observation, NSAIDs, DMARDs, splinting, corticosteroid injections login to view 4 more bullets Operative arthrodesis of thumb MCP joint login to view 19 more bullets arthrodesis of finger MCP joint login to view 11 more bullets arthroplasty of thumb MCP joint login to view 11 more bullets arthroplasty of finger MCP Joint login to view 24 more bullets Techniques Nonoperative observation, NSAIDs, DMARDs, splinting, corticosteroid injections login to view 17 more bullets pros/cons login to view 2 more bullets Arthrodesis of thumb MCP joint indications login to view 3 more bullets thumb MCP joint login to view 28 more bullets Arthrodesis of finger MCP joint indications login to view 1 more bullet approach login to view 3 more bullets technique login to view 9 more bullets complications login to view 4 more bullets Arthroplasty of thumb MCP joint indications login to view 2 more bullets approach login to view 2 more bullets technique login to view 2 more bullets complications login to view 4 more bullets Arthroplasty of finger MCP joint indications login to view 1 more bullet approach login to view 6 more bullets techniques login to view 10 more bullets complications login to view 6 more bullets Complications Nonunion incidence login to view 2 more bullets risk factors login to view 3 more bullets diagnosis login to view 1 more bullet treatment login to view 2 more bullets Surgical Site Infections incidence login to view 2 more bullets risk factors login to view 3 more bullets diagnosis login to view 2 more bullets treatment login to view 4 more bullets Hardware Failure incidence login to view 3 more bullets risk factors login to view 4 more bullets diagnosis login to view 2 more bullets treatment login to view 3 more bullets