Swan Neck Deformity
Other Names
- Swan Neck Deformity
- Swan-Neck Deformity
- SND
Background
- This page refers to the so-called 'Swan Neck Deformity' of the hand
History
- Surgical treatment first described in 175[1]
Epidemiology
- Not well defined in the literature
Pathophysiology
General
- Degenerative condition, 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
- Diagnosis is made clinically
- Treatment is a splinting in hyperextension, surgical tenotomy of the central slip in refractory cases
Etiology
- Acute
- Trauma including direct below and subsequent Mallet Finger injury
- Flexor Digitorum Superficialis laceration
- Chronic
Associated Conditions
- Rheumatoid Arthritis
- Seen in half of patients (need citation)
- Scleroderma
- Psoriatic Arthritis
- Systemic Lupus Erythematosus
- Ehlers Danlos Syndrome
Risk Factors
- Rheumatoid Arthritis
- Female > Male [2]
Differential Diagnosis
Differential Diagnosis Finger And Hand Pain
- Fractures
- Dislocations
- Tendinopathies
- Extensor Tendon Injuries of the Hand
- Central Slip Extensor Tendon Injury
- Flexor Tendon Injuries of the Hand
- Boutonniere Deformity
- Swan Neck Deformity
- Jersey Finger
- Mallet Finger
- Trigger Finger
- De Quervains Tenosynovitis
- Volar Plate Avulsion Injury
- Sagittal Band Injury
- Mannerfelt Lesion (FPL Rupture)
- 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
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.[4]
- 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 hyperextension of PJPJ
- Progressive extension splinting
- Physical Therapy
- Hand therapy with passive stretching
Operative
- Indications
- Progression despite conservative management
- Technique
- FDS Tenondesis
- Tenotomy of the central slip
Rehab and Return to Play
Rehabilitation
- Needs to be updated
Return to Play/ Work
- Needs to be updated
Complications and Prognosis
Prognosis
- Needs to be updated
Complications
- Incomplete correction of deformity
- Recurrence
- Chronic pain
See Also
Internal
External
References
- ↑ Nalebuff, Edward A., and Lewis H. Millender. "Surgical treatment of the swan-neck deformity in rheumatoid arthritis." Orthopedic Clinics of North America 6.3 (1975): 733-752.
- ↑ 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:
2 February 2025 23:32:27
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