Metacarpal Pain

Overview

The metacarpals are long bones in the hand, connected on one end to the wrist and the other to the finger bones or phalanges. The tops of the metacarpal bones form the knuckles and on the palm side, connective tissue covers them.

The most common cause of swelling with metacarpal joint pain is due to rheumatoid arthritis, an inflammatory condition where the lining of hand and finger joints make substances that erode the ligaments, cartilage and tendons in this area.

The second most common cause of pain and swelling is from other types of arthritis such as osteoarthritis and post-traumatic arthritis, which cause erosion to the protective cartilage at the joints.

Metacarpal pain, and swelling in the metacarpal joints can come from a whole host of causes including:

• Fractures

Fractures can occur from accidents, trauma and sports (E.G. Boxer’s Break).  The fifth metacarpal (or little finger) is most common from hitting a hard object or falling onto the hand.  Typical symptoms are pain, swelling, bruising and tenderness of the little finger.  The finger may even appear crooked and may not straighten when the fingers are fully extended.

• Joint Dislocation

The Metacarpal joints can dislocate in accidents and involve splinting, casting or surgery for correction.  Immobilization for prolonged times should be avoided as it will impinge upon hand functioning.

• Trauma from Repetitive Motions

Recurring motions (like typing on a keyboard) can cause pain from swelling or actual joint damage.  Splints and therapy may eradicate the pain. However if the joint cartilage is worn down over time the deep joint or aching pain during fine motor actions may be longer lasting.

• Metacarpal bossing

Here, a small lump at the carpometacarpal joint occurs due to trauma of the hand although it can occur spontaneously. The lump can give local discomfort but surgery is not necessary in most cases.

• Ganglions

Ganglions are swellings around joints associated with repetitive motions with the joints, strenuous activity, weight- lifting and playing guitar.

• Gout

Gout causes severe pain from uric acid accumulation around the joints. They become swollen, red and are hot to the touch with decrease in range of motion.

• Pseudo Gout

This condition causes pain and inflammation of joints due to excess buildup of crystal deposits.

• Glomus tumor

This benign vascular tumor causes pain, trigger point tenderness and intolerance to cold. One sees swelling, blue discoloration and ridging of fingernails.

• Bone Cysts

Bone cysts are enclosed fluid collections that appear as a growth near the joint causing pain until it is aspirated (drained)

• Heberden’s Nodes

Deformities, typically found in the elderly, at the margin of the middle and index finger joints cause pain and stiffness.

• Synovial giant cell tumor of joints or tendon sheaths

These are firm, asymptomatic growths from the tendon sheath and do not reoccur if removed.

• Dupuytren’s Contracture

This is a condition where small nodules under the skin of the palm forms and as it grows, a finger stays bent in a flexed position. Aching and itching may occur.

Medical Conditions Associated with Metacarpal Pain

There are a variety of additional medical conditions that can lead to MCP joint pain:

• Diabetes mellitus- a condition affecting blood sugar levels due to improper use of insulin or insufficient manufacture of insulin. Diabetes can damage joints (arthropathy) causing pain although 47% of those suffering from arthritis have diabetes as well.
• SLE (systemic lupus)- joint pain and inflammation are frequently associated with SLE, an autoimmune disease that attacks your own body organs and tissues.
• Raynaud’s phenomenon- decreased blood flow from a narrowing of capillaries and small blood vessels in the cold.
• Systemic sclerosis- autoimmune disease where there is excessive manufacture and deposits of collagen
• Wegener’s granulomatosis- blood vessel inflammation and formation of granulomas can affect joints as well as other body organs.
• Mucopolysaccharidosis- a genetic disease where the body lacks enzymes to breakdown mucopolysaccharides (long chain sugar molecules) in the cells causing a buildup n cells and body tissues.
• Dermatomyositis- inflammatory disease of muscles that may also cause joint pain.
• Polymyositis- muscular inflammatory disease which affects both muscles and related tissues.
• Rheumatoid arthritis- autoimmune condition affecting joints and cartilage
• Osteoarthritis- inflammatory condition of the joints due to repetitive usage causing breakdown of cartilage with deficiency of lubricants. Bones grind
• Psoriasis -autoimmune disorder affecting skin and joints
• Dermoid cyst- benign cystic tumor of enclosed body tissues found anywhere in the body including around joints

Treatment for Metacarpal Pain

Pain Alleviation

1. NSAIDS (ANTI-INFLAMMATORY DRUGS)

These are nonprescription medications taken by mouth or topically to relieve pain and inflammation, restoring function and daily activities.

1. Analgesics

Prescribed pain medication, in therapeutic doses are taken for more severe metacarpal joint pain.

  3. Corticosteroids

These are injected for severe chronic pain and considered for short-term use.

1. Prescribed Drugs for Arthritic Conditions

Methotrexate or hydroxychloroquine are typically the medications prescribed to thwart attack on the joints by the immune system for pain and symptom relief.

Surgery

Joint fusion or surgery is performed for fractures or dislocations. Joint realignment alleviates the pain.

Physical Therapy

• Stretching exercises are used to strengthen the muscles surrounding the metacarpal joint to maximize the range of motion.
• A program of exercises is devised to alleviate pain and inflammation at the joints affected.
• Therapy is given to restore the function of the affected hand so normal daily activities may be performed.

Chiropractic Treatments

Chiropractors focus on the musculoskeletal system in terms of overall health with natural noninvasive therapies.

Treatments include:

• Glucosamine– a sugar protein that helps build cartilage near joints for pain relief.
• Chondroitin– made of natural sugar chains to help maintain fluid and flexibility in the joints, decreasing pain and increasing daily normal function.
• Topical Creams Containing Natural ingredients (menthol/capsaicin) for pain relief and decrease of inflammation
• Acupuncture– gives relief from acute and chronic metacarpal joint pain
• Massage– expands the range of motion in affected joints, stimulates circulation around the joints, and reduces both pain and inflammation.
• Hydrotherapy- enables the patient to move easier under water, (especially with severe arthritis), relieves pain, and decreases inflammation
• Taping– use of kinesiology tape to affected area decreases pain and inflammation in the metacarpal joint.  This therapy lasts several weeks with each new tape application after several days

 

---

---

 

REFERENCES

1. Ashkenaze DM, Ruby LK. Metacarpal fractures and dislocations. Orthop Clin North Am 1992; 23:19.
2. Chung KC, Spilson SV. The frequency and epidemiology of hand and forearm fractures in the United States. J Hand Surg Am 2001; 26:908.
3. Geissler WB. Operative fixation of metacarpal and phalangeal fractures in athletes. Hand Clin 2009; 25:409.
4. Hettiaratchy SP, Nanchahal J. Synovial chondromatosis of the metacarpophalangeal joint. Journal of Hand Surgery. 2002;27B(1):104–106. [PubMed
5. Linden O. Case of chondromatosis of a metacarpophalangeal joint. European Journal of Surgery. 1934;75:181. [Google Scholar]
   
6. Soong M, Got C, Katarincic J. Ring and little finger metacarpal fractures: mechanisms, locations, and radiographic parameters. J Hand Surg Am 2010; 35:1256.
7. https://www.mayoclinic.org/diseases-conditions/arthritis/diagnosis-treatment/drc- 2035077
8. 2015 American Society for Surgery of the hand http://www.assh.org/handcare/hand-arm-conditions/MP-Joint-Arthritis