The metacarpophalangeal joint (MPJ) is the large joint where the finger connects to the hand. The proximal interphalangeal (PIP) joint is the middle joint of the finger. If pain occurs at these joints, initial treatment consists of buddy-taping the finger to its neighbor and an injection. If the injection works, but wears off, the injection can be repeated.
If pain persists after two injections, it is often because a ligament has been partially torn and the torn part is folded into the joint. This can irritate and inflame the joint, similar to irritation due to a pebble in a shoe.
These cases respond extremely well to arthroscopic debridement. The torn part of the ligament is shaved out and the pain relief is usually significant. If the underlying cause is found to be early arthritis, that will be revealed and appropriate management discussed (please see previous blogs).
Both metacarpophalangeal joint arthroscopy and proximal interphalangeal joint arthroscopy are minimally-invasive procedures performed on an outpatient basis. The “stab wounds” are small and pain is usually minimal. Early motion is encouraged. Stiffness is uncommon, and the need for post-operative hand therapy is often short. The wounds only need to be kept dry for 3 days, and then showering is permitted. Heavy use and power grip are best avoided for a week or two.
In short, both metacarpophalangeal joint arthroscopy and proximal interphalangeal joint arthroscopy are minimally-invasive procedures that are helpful to both diagnose and treat many disorders of the metacarpophalangeal joints and proximal interphalangeal joints that have failed appropriate non-operative management.