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Swan Neck Deformity

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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


Risk Factors

  • Rheumatoid Arthritis
  • Female > Male [1]

Differential Diagnosis


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


References


  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.
Created by:
John Kiel on 23 August 2019 17:00:28
Authors:
Last edited:
10 November 2021 01:00:40
Categories: