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. 2012 Dec;7(4):431-4.
doi: 10.1007/s11552-012-9437-x.

Locking of the metacarpophalangeal joint caused by idiopathic intrinsic muscle atrophy of the hand: report of three cases

Hiroaki Takai  1 , Yoshitaka Hamada, Ichiro Tonogai, Naohito Hibino
Affiliations

Locking of the metacarpophalangeal joint caused by idiopathic intrinsic muscle atrophy of the hand: report of three cases

Hiroaki Takai et al. Hand (N Y). 2012 Dec.
No abstract available

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Figures

Fig. 1
Fig. 1
Case 1. General appearance of the right hand. a The patient was able to achieve full flexion. b At the finger extension, the MP joint could not be extended because of locking
Fig. 2
Fig. 2
Case 1. Intraoperative photograph. There was severe deviation in the volar direction of the intrinsic extensor tendon of the middle finger. The arrows indicate a sliding of the proximal intrinsic muscle insertion and b the intrinsic extensor tendons with strong tension in the deep volar position. Locking between the intrinsic extensor tendons with strong tension in the deep volar position (arrow in b) and metacarpal head was observed. This intrinsic extensor tendon with strong tension in the deep volar position moved to the dorsal surface of the metacarpal head with unlocking upon extension of the MP joints
Fig. 3
Fig. 3
Case 1. Postoperative photograph at 6 months after the surgery. Improvement of ulnar drift as well as intrinsic tightness was observed. No sign of recurrence was noted a at finger extension and abduction and b at finger flexion
Fig. 4
Fig. 4
Case 2. a General appearance of both hands at the initial consultation. Upon finger extension, intrinsic plus deformity was observed, and the MP joint could not be extended because of intrinsic tightness at the affected right hand. The symptom was irreversible locking of the right middle finger and reversible locking of the ring and index fingers. An intrinsic plus contracture was observed at the initial consultation. b General appearance of the affected right hand at 6 months after surgery. At finger extension, the intrinsic plus deformity was improved, and the MP joint could be extended
Fig. 5
Fig. 5
Schematic drawing of the reversible locking (snapping) mechanism at the early stage between the extensor hood and metacarpal head. The lateral band snapped palmar to the axis of the MP joint in flexion due to the shortened muscle/tendon unit of the interosseous muscle. a Locking in flexion of the MP joint is caused by deviation of the tense extensor lateral band deep in the palmar direction, after being pulled by increased tension in the atrophic interosseous muscle. b Unlocking with finger extension was achieved if the interosseous lateral tendon was raised over the metacarpal head
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