Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Capsulotomy for metacarpophalangeal contracture


Indications

  • Metacarpophalangeal (MCP) joint stiffness can usually be prevented or corrected with nonoperative management, such as edema control, splinting, and early joint mobilization. About 90% of patients with MCP contractures are successfully treated nonoperatively. MCP capsulotomy is indicated in motivated patients with persistent contracture and hand dysfunction after several months of therapy.

  • Surgery is one part of the treatment plan for MCP contracture. Postoperative hand therapy is critical to maximize joint motion and treat scars, hypersensitivity, and edema. Patients and therapists should meet before surgery to discuss expectations. Patients must understand and commit to the plan.

Contraindications

  • One contraindication for the procedure is an inability to attend postoperative hand therapy. The patient must have access to a capable hand therapist and be willing to attend therapy several times per week.

  • It is also essential to ensure that the patient and therapist will be permitted to work together; preoperative payor (insurance) authorization should be confirmed when necessary.

Clinical examination

  • The goal of the examination is to identify the source of stiffness. Pathology in the soft tissue, capsuloligamentous structures, muscles, tendons, or bone can contribute to MCP contracture. See Table 104.1 for additional details.

    TABLE 104.1
    Etiology and Treatment of Metacarpophalangeal Contracture
    Category Involved Structures Operative Treatment Options
    Soft tissue Skin, subcutaneous tissue, fascia Scar release, skin graft, flap
    Capsule/ligament Joint capsule, collateral ligaments, volar plate Capsulotomy or capsulectomy, collateral ligament release, release of volar plate adhesions
    Muscle/tendon Extensor or flexor tendons, intrinsic tendons, tenosynovium Tenolysis, tendon lengthening, intrinsic release, tenosynovectomy
    Bone Articular incongruity, bone block Arthroplasty, arthrodesis

  • Examine the quality and compliance of the skin. An injured MCP joint typically assumes an extended posture. Scar contracture or dorsal skin deficiency sometimes contribute.

  • Passive and active range of motion (ROM) are carefully evaluated. Passive motion that exceeds active motion suggests pathology in the muscle or tendon. When active and passive motion are equal, the cause of stiffness is likely capsuloligamentous scarring or a bone block. When the joint does not move at all, it is impossible to localize the problem. Joint releases can be done first to get the joints mobile before tackling the tendon etiology.

Imaging

Standard, three-view radiographs of the hand are mandatory to evaluate the joint surfaces and rule out bony blockade or exostoses.

You're Reading a Preview

Become a Clinical Tree membership for Full access and enjoy Unlimited articles

Become membership

If you are a member. Log in here

Related Posts