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Swan Neck Deformity
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Contents
Other Names
- Swan-Neck Deformity
- SND
Background
- This page refers to the so-called 'Swan Neck Deformity' of the hand
History
Epidemiology
Pathophysiology
- 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
- Dislocations
- Tendinopathies
- Ligament Injuries
- Neuropathies
- Arthropathies
- Nail Bed Injuries
- Pediatric Considerations
- Other
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
See Also
External
- Sports Med Review Hand Pain: https://www.sportsmedreview.com/by-joint/hand/
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
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Last edited:
16 October 2022 00:18:36
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