REIDER PART 128
118 Chaitkr 4 Hand and Wrist
Figurę 4-25. A, Normal alignment, dorsal vicw. B, Normal alignment, sagittal view.
Figurę 4-26. Ulnar deviation of metacarpophalangcal joints in rheumatoid arthritis.
the loss of thc transverse arch of the hand due to the loss of the thenar and hypothenar muscles.
Joint Dislocations. Dislocations of the PIP joint are com-mon and disrupt normal sagittal alignment. Most com-monly, the middle phalanx displaces dorsally, producing a visiblc step-off at the PIP joint. Dislocations of the MCP joints are morę unusual. In this case, the proximal pha-lanx usually dislocates dorsally on the head of thc corre-sponding metacarpal. In addition to the dorsal swclling created by thc displacement of the proximal phalanx, a volar bulge may also be visible due to the prominence of the metacarpal head in the palm. Dislocation of the
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