Swan Neck Deformity: Symptom, Diagnosis, Treatment

Overview

Swan neck deformity is a finger condition characterized by the flexion of the distal joint (behind the nail) of the finger, and the extension of the proximal joint (close to the nail).

 

Symptom

Symptoms of swan neck deformity include

  • the middle knuckle bending backward (hyperextends) and the fingertip bending down towards the palm,
  • difficulty bending the middle knuckle when making a fist,
  • pain in the middle knuckle and difficulty using hand.

 

Cause and Risk Factor

Swan neck deformity may result from factors like

  • rheumatoid arthritis (most common)
  • untreated mallet finger (due to rupture of lateral slips at their junction with bone)
  • poorly healed fracture in the finger
  • nerve damage that causes muscle spasms
  • severely jammed finger tip
  • cerebral palsy (due to muscle imbalance)
  • congenital joint laxity
  • ruptured finger tendon or tendons
  • some genetic conditions, such as Ehlers-Danlos syndrome

In conclusion, it can be seen in conditions like

  • rheumatoid arthritis (classical association)
  • post-traumatic: particular post mallet finger injury
  • scleroderma
  • psoriatic arthritis
  • systemic lupus erythematosus arthropathy

 

Diagnosis

Doctors diagnose swan neck deformity with a visual examination of the hands. The doctor will look for a hyper extended middle joint (PIP) and check whether the tip of the finger is flexing inwards to point towards the palm.

In addition to determining if a patient has swan neck deformity, a doctor will look to diagnose the cause. For people with rheumatoid arthritis, the most likely cause is the arthritis.

If rheumatoid arthritis is not the cause, a doctor may order an X-ray of the finger or fingers to determine if an acute injury may be the cause.

 

Treatment

There are both surgical and non-surgical treatments for swan neck deformity.

Non-surgical options

  • finger brace
  • stretching
  • massage
  • joint mobilization

Surgical options

  • skin release
  • ligament reconstruction
  • soft tissue surgery
  • finger joint fusion
  • PIP joint arthroplasty (surgical repair of the proximal interphalangeal joint, or replacement of the joint or part of the joint by metal or plastic parts)
  • joint replacement

 

Keywords: swan neck deformity.

 

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