The finger MCP joints are condyloid joints allowing flexion-extension in all positions and abduction-adduction only in extension (when the cam-shaped metacarpal head allows side-to-side motion). In flexion, the cam of the metacarpal head locks the collateral ligaments taut, preventing deviation, explaining why MCP joints must be splinted in flexion after injury to prevent collateral ligament contracture.
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MCP joint collateral ligament injuries from hyperextension or deviation are splinted with the joint in 70-90 degrees of flexion (intrinsic plus position) to keep collaterals at maximum length and prevent shortening. Dorsal MCP dislocations usually reduce closed, but complex dislocations with the volar plate trapped in the joint are irreducible and need open reduction. In rheumatoid arthritis, synovitis stretches the radial collateral ligaments and sagittal bands, producing ulnar drift and volar subluxation of the fingers. MCP joint arthroplasty (silicone or surface replacement) for rheumatoid arthritis reliably improves alignment and function.
Radial or ulnar collateral ligament injury from deviation force producing lateral MCP joint pain managed with buddy taping in flexion.
Dorsal dislocation from hyperextension; simple dislocations reduce closed, while complex ones with the volar plate trapped in the joint need open reduction.
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