With the advancements in arthroscopic technique, arthroscopy has become feasible in most human joints, even those as small as the finger joints. The metacarpophalangeal joints are very well suited for arthroscopy and arthroscopic therapy. Good results have been reported on arthroscopic synovectomy of the metacarpophalangeal joints in rheumatoid arthritis. Osteochondral lesions in degenerative arthritis, loose bodies and foreign bodies can well be treated. Arthroscopic arthrolysis for capsular contracture and treatment of post-traumatic lesions have been performed successfully. The arthroscopic assistance in the treatment of intraarticular fractures and the capsular shrinkage for instability have been described. However, metacarpophalangeal joint arthroscopy has not been popularised up to now and its role in clinical practice remains to be established. Existing indications will be discussed with respect to our own experience.