Evaluating MCP Joint Dislocations

Reduction Techniques

Topic: Evaluating MCP Joint Dislocations

Greetings colleagues,

Welcome to the Hands-On The East Bay Newsletter, which summarizes key topics in hand surgery for providers on the front lines. I'm Dr. Jesse Dashe, an orthopedic hand surgeon at the East Bay Hand Medical Center.

Question:

What are tips for reduction?

Answer: 

  • Adequate analgesia or anesthesia is essential.

  • Avoid excessive force or axial traction, which can entrap soft tissues and make the dislocation irreducible.

  • The goal is to reverse the mechanism of injury.

Question:

What are the dorsal dislocation tips?

Answer: 

  1. Flexion at the Wrist: This relaxes the flexor tendons.

  2. Pressure Application: Apply gentle but firm pressure on the base of the dislocated phalanx while the MCP joint is held in slight flexion.

  3. Controlled Manipulation: Gently guide the phalanx back over the metacarpal head.

Question:

What are the volar dislocation tips?

Answer: 

  1. Wrist Extension: To relax the flexor tendons.

  2. Dorsal Pressure: Apply pressure dorsally on the proximal phalanx.

  3. MCP Extension and Phalanx Manipulation: While maintaining dorsal pressure, slowly extend the MCP joint and guide the phalanx into proper alignment.

Question:

What are the lateral dislocation tips?

Answer: 

  1. Flexion of MCP Joint: This helps in loosening the joint capsule.

  2. Lateral Pressure: Apply lateral pressure on the dislocated phalanx in the opposite direction of the dislocation.

  3. Alignment: Gradually realign the phalanx with the metacarpal head.

Question:

What is the post-reduction treatment?

Answer: 

  • Immobilization: After successful reduction, immobilize the MCP joint in its safe position, usually slight flexion.

  • Reassessment: Reassess neurovascular status and confirm reduction with post-procedure imaging.

  • Refer: Send to a hand surgeon for further management.

Please feel free to reach out if you have any questions or would like to refer any patients. You can refer patients at handreferral.com or by using this link:

If you need to reach me directly, please respond to this email or email me at [email protected].

Please contact me so I can come by your facility to meet face-to-face and/or give presentations, splinting sessions, etc.

Lastly, let me know if you have any other hand topics you would like covered in the future!

Sincerely,