The metacarpophalangeal joints are the knuckle joints of the hand, condyloid joints that allow both finger flexion-extension and spreading (abduction-adduction in extension). The collateral ligaments are lax in extension and tight in flexion, which is why MCP joints must be immobilised in flexion to prevent collateral ligament contracture in burns and injury management. The MCP joints are primary targets of rheumatoid arthritis and gout.
MCP joint collateral ligament tightness from immobilisation in extension is the major preventable complication of hand injury management, which is why the Edinburgh position (MCP joints in 90 degrees flexion, IP joints extended) is used for hand splinting. Rheumatoid arthritis produces MCP joint synovitis leading to ulnar drift deformity from attenuation of the radial collateral ligaments and volar plate.
Radial or ulnar collateral ligament injury from a varus or valgus force to a finger, producing lateral joint tenderness and instability testing, managed with buddy taping except for the thumb which requires more formal assessment.
Inflammatory synovitis producing progressive MCP joint destruction, ulnar drift, and volar subluxation requiring splinting, disease-modifying therapy, and eventually joint arthroplasty.
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