Swan Neck Deformity

Other Names

Swan-Neck Deformity
SND

Background

This page refers to the so-called 'Swan Neck Deformity' of the hand

History

Epidemiology

Pathophysiology

Swan neck deformity in a patient with rheumatoid arthritis

General
- Characterized by hyperextension of PIPJ and compensatory flexion of DIPJ
- Occurs as a result of an injury to the Volar Plate
- Subsequently, extension forces exceed flexion forces at the PIPJ

Etiology

Acute
- Trauma including direct below and subsequent Mallet Finger injury
- Flexor Digitorum Superficialis laceration
Chronic

Risk Factors

Rheumatoid Arthritis
Female > Male ^[1]

Differential Diagnosis

Fractures
- Phalanx Fractures (Hand)
- Metacarpal Fractures
Dislocations
Tendinopathies
Ligament Injuries
- Gamekeepers Thumb (UCL)
- Radial Collateral Ligament of the Thumb Injury (RCL)
Neuropathies
Arthropathies
Nail Bed Injuries
Pediatric Considerations
- Proximal Phalanx Avulsion Fracture (Thumb)
- Middle and Distal Phalanx Avulsion Fracture
Other
- Dupuytrens Contracture

Clinical Features

History
- Patient will report snapping, locking, stiffness and difficulty bending the PIPJ
Physical Exam: Physical Examination Hand
- Inspection of the affected digit should demonstrate extended PIPJ and flexed DIPJ
- Generally these are non-mobile

Evaluation

Swan neck deformities in all 5 digits of the right hand as a result of systemic lupus^[2]

Radiographs

Standard Radiographs Hand
- Typically adequate to help support the diagnosis
Findings
- Hyperextension of a proximal interphalangeal (PIP) joint
- Flexion of a distal interphalangeal (DIP) joint

Classification

Nalebuff Classification

Type 1: PIP joint is flexible in all positions of the MCP joint.^[3]
Type 2: PIP joint flexion is limited in certain positions of the MCP joint.
Type 3: PIP joint flexion is limited irrespective of the position of the MCP joint.
Type 4: PIP joints are stiff and have a poor radiographic appearance

Management

Nonoperative

Indications
- Vast majority
Immobilization
- Double ring splint or extension block splint to help prevent hyperextenion of PJPJ
- Progressive extension splinting
Physical Therapy
- Hand therapy with passive stretching

Operative

Indications
- Progression despite conservative management
Technique
- FDS Tenondesis

Rehab and Return to Play

Rehabilitation

Needs to be updated

Return to Play/ Work

Needs to be updated

Complications and Prognosis

Prognosis

Complications

Incomplete correction of deformity
Recurrence
Chronic pain

References

↑ Sharif K, Sharif A, Jumah F, Oskouian R, Tubbs RS. Rheumatoid arthritis in review: Clinical, anatomical, cellular and molecular points of view. Clin Anat. 2018 Mar;31(2):216-223.
↑ Case courtesy of Dr Matt A. Morgan, Radiopaedia.org, rID: 37569
↑ Boyer MI, Gelberman RH. Operative correction of swan-neck and boutonniere deformities in the rheumatoid hand. J Am Acad Orthop Surg. 1999 Mar-Apr;7(2):92-100.

Created by:

John Kiel on 23 August 2019 17:00:28

Authors:

John Kiel

Last edited:

16 October 2022 00:18:36

Categories:

Trauma | Arthropathies | Finger | Upper Extremity

[1] Sharif K, Sharif A, Jumah F, Oskouian R, Tubbs RS. Rheumatoid arthritis in review: Clinical, anatomical, cellular and molecular points of view. Clin Anat. 2018 Mar;31(2):216-223.

[2] Case courtesy of Dr Matt A. Morgan, Radiopaedia.org, rID: 37569

[3] Boyer MI, Gelberman RH. Operative correction of swan-neck and boutonniere deformities in the rheumatoid hand. J Am Acad Orthop Surg. 1999 Mar-Apr;7(2):92-100.

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