What is an MCP joint replacement?
The MCP joints are the large knuckles at the base of your fingers, often referred to as ‘back knuckles’. These joints enable us to position our fingers correctly during tasks, as well as allowing for strong gripping and pinching. We use our hands in this way throughout the day so these joints can wear down and become painful. Some conditions, such as rheumatoid arthritis, can also cause joint changes.
You may have noticed some deformity at these joints, a loss of movement and less ability to use your hand normally. A MCP joint replacement involves removing the old joint and replacing it with a new two piece pyrocarbon joint.
What might I expect following surgery?
Following surgery your hand will be rested in a plaster splint with a bulky bandage for comfort. You will normally be seen by our hand therapy team within the first one to two weeks following your surgery.
Your plaster splint will be replaced with a light weight thermoplastic splint. You will also be given a splint which you will use for exercises. Following this you will then be seen on a regular basis to progress your hand therapy.
How do I look after my wound and why might my hand swell?
Following surgery it is important that you keep your dressing dry to avoid problems with your wound. Normally your stitches will be removed 14 days following your surgery.
Once your wound is fully healed you will be shown how to use vasoline or sweet almond oil to massage your scar. You will be shown how to massage your scar to help prevent any excess scar tissue from causing problems and limiting your movement in your hand in the long term.
You will also be given advice regarding how to manage swelling in your hand. This may include elevating your hand above your heart level or through the use of compression (glove or tubigrip).
Why do I need to protect my joint replacements?
Following your surgery your new joints need protection to prevent them from further damage. The splint will help to protect your joint replacement. The splint is designed to hold your fingers straight and must be worn for 24 hours a day.
The splint can be removed only for exercises and careful hand cleaning. Your splint must be worn at all times normally for the first four weeks and then at night and protection outdoors for a further four weeks unless advised by your therapist. From time to time your splint may need to be remoulded.
Why is it important to exercise?
Following surgery to replace your MCP joint/s your hand will be swollen and stiff and it is important to exercise to restore the movement and function of your hand. Exercises will also help with preventing scar tissue from adhering to structures in your hand that may restrict your movement.
You will be taught the following exercises to help to restore the movement in your hand. Normally these exercises are completed every one to two hours throughout the day repeating each exercise 10 times.
Place the blocking splint against your palm. Start with a straight hand and bend your back knuckles to the splint, trying to keep the other finger joints straight.
The blocking splint angle will be increased later in your rehabilitation.
Curl the tips of your fingers into a hook shape while keeping your back knuckles straight then straighten your fingers again.
You might be given a board or splint to help with positioning for this exercise.
Week four onwards
What important advice should I follow?
- During the first four weeks you will not be able to use your hand for any activities as you will risk damaging your hand and your replaced joint/s. Following this you will be able to commence light daily activities with your hand. Eight weeks following your surgery you can return to your normal activities.
- Driving is not advised for the first six weeks due to potential strain on the new joints.
- It is important that you keep your unaffected joints moving normally including your shoulder and elbow as they can stiffen if they remain still.
- If you notice any sudden pain, swelling, redness or a change in your fingers ability to move or your splint becomes too loose or tight please contact the hand therapy team.
Who should I contact if I have any problems?
South Tees Hospitals NHS Foundation Trust would like your feedback. If you wish to share your experience about your care and treatment or on behalf of a patient, please contact The Patient Experience Department who will advise you on how best to do this.
This service is based at The James Cook University Hospital but also covers the Friarage Hospital in Northallerton, our community hospitals and community health services.