Chronic Extension Contracture Left 2nd, 3rd & 4th MCP Joint: A Case Report

Abstract

Introduction: Extension contracture of the metacarpophalangeal (MCP) joint is an uncommon condition that impairs hand function, particularly when affecting the 2nd, 3rd & 4th digits. Often under-recognized, it presents diagnostic and therapeutic challenges. Early identification and appropriate management are essential to prevent long-term stiffness and restore functional range of motion in affected joints. Case Illustration: A 37-year-old male presented with persistent stiffness in the left wrist and the 2nd, 3rd & 4th digits of the left hand, ongoing for five years. He had a history of trauma 20 years ago, resulting in recurrent ulcers, multiple debridements, and chronic stiffness. X-rays and MRI revealed a lunate fracture, soft tissue fibrosis, and joint instability. The patient underwent extensor contracture release with Z-plasty and Kirschner wire stabilization. Postoperatively, he exhibited improved wrist mobility but persistent restricted motion in the third finger, requiring further evaluation. Discussion: Extension contractures of the metacarpophalangeal (MCP) joints, particularly in the 2nd, 3rd & 4th, are rare but significantly impair hand function. These contractures often result from post-traumatic fibrosis and capsular adhesion, exacerbated by immobilization. Conservative therapies may fail, necessitating surgical intervention such as tendon release and Z-plasty. Postoperative rehabilitation is crucial to prevent recurrence and maintain hand function. This case highlights the importance of early diagnosis and individualized surgical treatment, with positive functional outcomes achieved through extensor tendon release and joint stabilization. Further studies are needed to establish comprehensive treatment protocols for this condition. Conclusion: This case underscores the significance of early diagnosis, advanced imaging, and personalized surgical planning in managing chronic wrist stiffness and digital contracture, highlighting partial improvement but residual deformity following surgical intervention.