Nasser Hyder - Orthopaedic Hand, Wrist and Trauma Surgeon Your Practice Online
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After Care and Therapy

MCPJ Replacement

The knuckles joints (MCPJ) of fingers are very often severely affected in patients with Rheumatoid Arthritis (RA). The joint has classical deformity of ulnar deviation and volar subluxation. As a result the function is limited. Most of these patients have involvement of other joints of fingers as well as the wrist. Pain is usually controlled by medications but deformity once severe can only be corrected by operation, which involves realigning the extensor tendon and also replacement with artificial MCP joints of all four fingers. As usual with hand surgery, after care including therapy and long period of splinting is required to achieve a satisfactory result. You will be referred to therapy before the operation for education of postoperative care and expectations from surgery.

The operation can be done under general anaesthesia or a regional nerve block. One or two night stay in the hospital is the normal. Hand swelling is expected and elevation is essential to minimise swelling.

0 - 2 Weeks

On discharge your wrist and hand will be in a plaster cast holding your fingers straight. The arm will be in a sling to reduce swelling. You will attend the OT (Occupational Therapy) department in about a week when the plaster will be changed and a splint will be made for your wrist. This is meant to keep the wrist at 30 degrees extension and the MCPJ at 30 degrees of flexion. In addition there will be a bar on the side of little finger preventing the finger from going into the deformity again. The fingers will be held by spring loaded loops again pulling the fingers towards the thumb to keep the deformity corrected. Active and active assisted flexion will begin. At night time your fingers will be strapped with Velcro to keep them straight preventing inadvertent movements of fingers during sleep (resting splint). At 2 weeks you will be seen in clinic where stitches will be removed.  

2 – 6 Weeks

During therapy sessions, splint can be removed to allow some wrist exercises. It may be necessary to take some pain killers before the therapy sessions. Finger exercises will continue. It is often necessary to adjust the splint depending on your progress. Further measures may be necessary to help reduce swelling. At about 6 weeks you should be able to flex the knuckle joint to about 40 - 60 degrees.

6 – 12 Weeks

The therapy sessions will continue. During the day it may be possible to take the splint off few times to exercise the fingers and the wrist. At 12 weeks day time splinting is discontinued. Resting night splint has to continue for another 12 weeks.

At the end of treatment, it is expected that your finger deformity will have been better and function improved with ability to straighten (extend) fully and bend (flex) fingers to about 60 to 70 degrees at the MCP joint.
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Hand & Wrist Elbow After Care and Therapy