The Zancolli principle of preventing metacarpophalangeal joint hyperextension by shortening the volar capsule is sound. We prefer to block hyperextension of the metacarpophalangeal joints by detaching the volar plate from the metacarpal neck, shifting it proximally, and inserting it into bone.
Capsulodesis, when performed in this manner, and when combined with pulley advancement, improves prehension. It allows the fingers to open by preventing hyperextension of the metacarpophalangeal joints, and improves the grasping pattern. It is indicated for simple clawing, when clinical testing shows that prevention of metacarpophalangeal
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joint hyperextension will correct the claw deformity. When there is a complicated clawing of the fingers due to flexion contracture of the interphalangeal joints or inability of the extrinsic extensor tendons to extend these joints when metacarpophalangeal hyperextension is prevented, preliminary relief of the contracture and active tendon transfers should be considered.