The Index Finger Metacarpal Tubercle

PURPOSE: The region of the index finger metacarpophalangeal joint is a common source of hand pain with variable, well-known etiologies. We have identified the tubercle at the dorsoradial neck of the index finger metacarpal as a distinct and specific site of pain in a subset of patients who presented with a chief report of index finger pain. Although experienced hand surgeons may recognize this clinical entity, we found no previous description within the literature. METHODS: After institutional review board approval, we performed a retrospective review of all patients presenting to a single surgeon practice with severe pain at the dorsoradial tubercle of the index finger metacarpal unattributable to known etiologies. Patients underwent initial management of steroid injection followed by surgical excision if conservative measures failed. RESULTS: Steroid injection was administered as initial management in 9 of 10 afflicted hands. Five of these hands experienced complete resolution of pain at 4 weeks after injection whereas 4 developed recurrence at an average of 3 months after injection. Among patients with recurrence, one patient opted for a second injection that led to pain resolution 4 weeks later, whereas the remaining 3 hands had surgical excision. All patients who underwent surgical excision reported minimal discomfort and marked improvement in pain after surgery. CONCLUSIONS: We identified the tubercle at the dorsoradial neck of the index finger metacarpal as a distinct and specific site of pain in a subset of patients. We postulate that the pathophysiology of pain at the prominent index finger metacarpal tubercle may be related to a subacute radial collateral ligament injury. Steroid injection to the tubercle is a reasonable initial treatment option and satisfactory results may also be obtained with surgical excision. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.