Jump to content
We need you! See something you could improve? Make an edit and help improve WikSM for everyone.

Carpometacarpal Joint Dislocation

From WikiSM

Other Names

  • Thumb CMC Dislocation
  • Thumb Carpometacarpal Joint Dislocation
  • Carpometacarpal Joint Fracture-Dislocation

Background

History

  • First case published by Cooper in 1832 (need citation)

Epidemiology

  • Rare, account for less than 1% of hand injuries[1]
  • More common in dominant hand
  • More often multiple dislocations rather than single isolated[2]
  • 50% involve 5th MCPJ, 25% 2nd MCPJ[3]

Pathophysiology

Small finger carpometacarpal (CMC) fracture dislocation anatomy.[4]
The CMC joints of the first through fifth fingers[5]
Labeled radiograph PA radiograph of the wrist[6]

General

  • Carpometacarpal joint dislocations are a relatively rare phemonenon
  • Fifth carpometacarpal joint is the most commonly injured
  • Optimal management is crucial in restoring pinch and grip strength, however there is no consensus regarding treatment due to paucity of literature
  • Delayed treatment results in poor functional outcomes and residual pain

Pathophysiology

  • Dorsal dislocations are more common than volar dislocations
  • Typically a single joint is dislocated, multiple CMC joint dislocations is very rate
  • Divergant dislocations (1 or more volar, 1 or more dorsal) is extremely rare[7]

Mechanism of Injury

  • General
    • High velocity injury is the most common MOI[8]
    • Punching
    • Fall
  • Thumb: traumatic
    • Axial load on flexed thumb
    • Dorsal force applied to 1st webspace
  • Thumb: degenerative
    • Can occur in relation to osteoarthritis, synovitis and postmenopausal laxity[9]

Associated Injuries

Anatomy of the Thumb Carpometacarpal Joint

  • Thumb joint (trapeziometacarpal joint) is the most specialized, flexible with the greatest range of motion
  • Articulation of trapezium, first metacarpal
  • Characterized as a synovial, curved saddle joint
  • Stabilized by 16 various ligaments

Anatomy of the Digits 2-5 Carpometacarpal Joints

Risk Factors

Demographic

  • Young males

Sports

  • Football
  • Skiing
  • Bicycling
  • Motorcycle

Differential Diagnosis

Differential Diagnosis Hand Pain

Clinical Features

(a) and (b) clinical pictures showing swelling over the dorsum of the hand in a patient with a second carpometacarpal joint dislocation[11]

History

  • Patients will report swelling, pain at affected joint(s)
  • Patients should be able to describe some type of trauma
  • Loss of range of motion, trouble gripping

Physical Exam: Physical Exam Wrist

  • Deformity may or may not be obvious depending on degree of swelling
  • Swelling around the wrist
  • Knuckle may appear "shortened" or "exaggerated" depending on direction of dislocation
  • Inability to form a fist

Evaluation

X-ray showing dislocation of thumb carpometacarpal joint.[12]
Patient with fourth ray carpometacarpal dislocation and fracture of the base of second metacarpal bone; preoperative X-rays (A and B) and postoperative control after closed reduction with Kirschner wires (C)[13]

Radiographs

CT

  • Role not well defined
  • May be useful to clarify extent of osseous injuries
  • Can identify ofccult or missed carpal fractures

MRI

  • Recurrent instability after reduction, evaluate soft tissue injuries

Classification

  • N/A

Management

Anteroposterior, oblique, and lateral radiographs of a complete articular fifth metacarpal base fracture with dorsal subluxation of the fifth CMC joint treated successfully with CRPP.[14]

Acute Management

  • Closed reduction at bedside if possible
  • Reduction in OR may be necessary

Nonoperative

Operative

  • Thumb Indications
    • Unstable joint, which is most cases
  • Goals[15]
    • Timely repair
    • Prevents chronic joint instability and arthritic pain
    • Maximizing return of function
  • Technique
    • Closed reduction percutaneous pinning (CRPP)
    • Open reduction internal fixation (ORIF)

Rehabilitation and Return to Play

Rehab

  • Post operatively
    • Following 6 weeks of immobilization
    • Light to moderate exercise
    • Strengthen/ lengthen soft tissue dynamic and static stabilizers

Return to play

  • Highly variable

Prognosis and Complications

Prognosis

  • Surgical outcomes data from 1st metacarpal fractures
    • For the thumb Lutz found no significant difference bewtween CRPP or ORIF treating Bennetts fracture[16]
    • Simonian and Trumble reported more degenerative arthritis, instability in patients initially treated with CRPP[17]
    • Simonian noted better outcomes in patients with ligamentous reconstruction
  • Surgical outcome from managing 1st CMC joint dislocation
    • ORIF alone insufficient in treatment of thumb CMC dislocation, must reconstruct capsule and ligaments[18]
    • Several studies have reported good outcomes using flexor carpi radialis grafts[19]

Complications

  • Chronic hand pain
  • Decreased grip strength
  • Joint instability or stiffness
  • Proximal migration of the metacarpal base
  • Dorsal prominence
  • Posttraumatic Arthritis
  • Loss of function
  • Inability to return to work/ sport

See Also

Internal

External

References

  1. ↑ Mueller, James J. "Carpometacarpal dislocations: report of five cases and review of the literature." The Journal of hand surgery 11.2 (1986): 184-188.
  2. ↑ Lefere, M., et al. "Rare carpometacarpal dislocations." Orthopaedics & Traumatology: Surgery & Research 102.6 (2016): 813-816.
  3. ↑ Fisher, Madeleine R., Lee F. Rogers, and Ronald W. Hendrix. "A systematic approach to the diagnosis of carpometacarpal dislocations." RadioGraphics 2.4 (1982): 612-627.
  4. ↑ Carruthers, Katherine H., et al. "Casting and splinting management for hand injuries in the in-season contact sport athlete." Sports Health 9.4 (2017): 364-371.
  5. ↑ Ayhan, Çiğdem, and Egemen Ayhan. "Kinesiology of the wrist and the hand." Comparative kinesiology of the human body. Academic Press, 2020. 211-282.
  6. ↑ Vos, F. M., et al. "A statistical shape model without using landmarks." Proceedings of the 17th International Conference on Pattern Recognition, 2004. ICPR 2004.. Vol. 3. IEEE, 2004.
  7. ↑ Pundkare, Gopal Tukaram, and Aniket Machindra Patil. "Carpometacarpal joint fracture dislocation of second to fifth finger." Clinics in Orthopedic Surgery 7.4 (2015): 430-435.
  8. ↑ Breiting, Vibeke. "Simultaneous dislocation of the bases of the four ulnar metacarpals upon the last row of carpals." The Hand 15.3 (1983): 287-289.
  9. ↑ Neumann, Donald A., and Teri Bielefeld. "The carpometacarpal joint of the thumb: stability, deformity, and therapeutic intervention." Journal of Orthopaedic & Sports Physical Therapy 33.7 (2003): 386-399.
  10. ↑ El-shennawy, Maged, et al. "Three-dimensional kinematic analysis of the second through fifth carpometacarpal joints." The Journal of hand surgery 26.6 (2001): 1030-1035.
  11. ↑ Alagesan, Saravanan, et al. "An Isolated Second Carpometacarpal Joint Dislocation Treated With Open Reduction and Transfixation With K-wire: A Rare Case Report." Cureus 16.3 (2024).
  12. ↑ Annappa, Rajendra, Prem Kotian, and Srikanth Mudiganty. "Ligamentous reconstruction of traumatic dislocation of thumb carpometacarpal joint: case report and review of literature." Journal of Orthopaedic Case Reports 5.4 (2015): 79.
  13. ↑ Telich-Tarriba, Jose E., et al. "Carpometacarpal joint dislocations: management and long-term outcomes at a specialized hand surgery center in Latin America." Plastic Surgery 28.4 (2020): 210-214.
  14. ↑ Berault, Thomas J., et al. "Operative Treatment of Non-Thumb Carpometacarpal Joint Fracture Dislocations." Journal of Hand Surgery Global Online 7.2 (2025): 139-145.
  15. ↑ Lahiji, Farivar, Reza Zandi, and Arash Maleki. "First carpometacarpal joint dislocation and review of literatures." Archives of Bone and Joint Surgery 3.4 (2015): 300.
  16. ↑ Sailer, M., et al. "Closed reduction transarticular Kirschner wire fixation versus open reduction internal fixation in the treatment of Bennett’s fracture dislocation." Journal of Hand Surgery 28.2 (2003): 142-147.
  17. ↑ Simonian, Peter T., and Thomas E. Trumble. "Traumatic dislocation of the thumb carpometacarpal joint: early ligamentous reconstruction versus closed reduction and pinning." The Journal of hand surgery 21.5 (1996): 802-806.
  18. ↑ SHAH, JAY, and MAHENDRA PATEL. "Dislocation of the carpometacarpal joint of the thumb: a report of four cases." Clinical Orthopaedics and Related Research® 175 (1983): 166-169.
  19. ↑ Iyengar, Karthikeyan, et al. "Modified Eaton-Littler’s Reconstruction for Traumatic Dislocation of the Carpometacarpal Joint of the Thumb—A Case Report and Review of Literature." Journal of hand and microsurgery 5.1 (2013): 36-42.
Created by:
John Kiel on 30 September 2019 13:22:50
Authors:
Last edited:
21 August 2025 19:11:50
Categories:
Retrieved from "https://wikism.org/w/index.php?title=Carpometacarpal_Joint_Dislocation&oldid=36714"