Diagnosis and Management of Pain around the MP Joint Caused by Soft Tissue Injuries

Journal of the Korean Society for Surgery of the Hand 2008;13(2):101-107.
Published online June 1, 2008.

In Hyeok Rhyou,Bo Gun Suh,Chaeik Chung,Kyung Chul Kim

중수지 관절 부위 연부 조직 손상에 의한 통증의 진단과 치료

류인혁,서보건,정재익,김경철

Abstract

Purpose
To evaluate the surgical results of treatment of the affected joint capsules and sagittal bands in patients with metacarophallangeal (MP) joint pain caused by the injuries of the joint capsule and sagittal bands. Materials and Methods: Eight patients with the pain around the MP joint unresponsive to non-operative treatment for at least six weeks were surgically managed. The affected joint capsules were primarily repaired (6 cases) or left open (2 cases) if the intraperative passive full flexions of MP joints were hindered. The associated sagittal bands were repaired to prevent the subluxations of extensor tendons. There were six males and two females between 16 and 53 years (mean 39) with average follow up of 13 weeks (6 weeks to 22weeks). Seven cases were evaluated with ultrasonogram(USG) or Maganetic Resonance imaging(MRI) to obtain objective findings. The results were evaluated with following parameters; disappearance of pain, the changes of the range of the motion (ROM) of the affected joints, postoperative extensor subluxations and postoperative wound complications. The specific findings of MRI or USG were investigated. Result: In six cases, pain completely disappeared within at least eight weeks except two cases; in one case, pain had persisted without relief of pain and in the other case with preoperative limitation of ROM and intraoperative severe synovitis, pain had aggravated. There were no subluxations of the extensor tendons and postoperative wound complications. The high signal in T2-wieghted fat suppression view in MRI and the low echogenisity around the affected joint capsules in USG were observed and provided objective findings to support the diagnosis. Conclusion: The joint capsule injuries with the associated sagittal band injuries may be one of the causes of pain around the MP joint. Excision of the affected joint capsule with or without repair can bring early pain relief. Because accompanying synovitis may aggravate postoperatively with preoperative ROM limitation of the involved the joint, the conservative treatment to improve the ROM and relieve synovitis should be considered initially.