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Swan Neck Deformity

What is a Swan Neck Deformity?

Swan Neck deformity is a malformation of the finger in which the DIP (or Distal Interphalangeal) joint is hyperflexed, or bent towards the palm, while the PIP (or Proximal Interphalangeal) joint is hyperextended, or bent away from the palm. This results in a finger that is bent in such a way as to resemble a swan’s neck, hence the name.

What causes a Swan Neck Deformity?

Rheumatoid arthritis is the most common cause of swan neck deformities. RA causes chronic swelling of the PIP joint, which in turn loosens the volar plate, which is a ligament on the palm side of the finger. Once loosened, this ligament tears easily, and when torn it leads to the hyperextension of the PIP joint. This hyperextension in turn causes the extensor tendon of the DIP joint to fall out of balance, and that joint then hyperflexes, which completes the appearance of the swan’s neck. A swan neck deformity can also be caused by trauma, specifically injuries to the volar plate of the fingers, sudden hyperextension of the PIP joint, or as the result of an untreated mallet finger.

What are symptoms of a Swan Neck Deformity?

Even before the telltale signs of the deformity in the fingers, there may be indicators that you could be developing a swan neck deformity. The most common of these is the gradual inability to close your fingers into a fist, but by this point the condition may have already progressed quite far. If you are not already suffering from rheumatoid arthritis prior to developing swan neck, then you may very well experience some symptoms similar to RA, such as swollen and painful joints, stiffness in the fingers and the inability to flex your fingers.

How to diagnose a Swan Neck Deformity

Due to the highly identifiable nature of this deformity, by the time the condition has development it is immediately apparent upon physical examination. X-ray and MRI scans are helpful to allow the doctor to explore the bones and determine if there are any fractures (as the result of trauma) and to gauge the health of the ligaments and joints.

Treatment Options

Non-surgical treatment of a Swan Neck Deformity

It is imperative that the balance of tension in the finger be restored to reverse the effects of a swan neck deformity, so it is likely that intense physical therapy will be necessary. This will consists of massaging, stretching and exercising the joint on a daily basis in order to restore and maintain mobility and flexion. There is also a particular splint that works very well at holding the PIP joint in place without holding it too tight, so that the joint repairs itself and the volar plate with enough give to allow future mobility.

Surgical treatment of a Swan Neck Deformity

Surgical treatment, while generally a last resort, is usually necessary in the case of swan neck deformities, as even the most rigorous therapy and splinting seldom have a lasting effect (although they are beneficial in preparation for post-surgical therapy). That being said, there are several surgeries that can be performed to reduce the effects of swan neck deformity. The least intensive is a general repair of the soft tissues around the joint, that is to say the skin, tendons and ligaments. This surgery requires intensive physical therapy afterwards, and is not always as successful as other surgical options. The next option is a total replacement of the PIP joint, in which the doctor removes the original damaged joint and replaces it with a joint made of metal or silicone. This joint, but its nature, will restore the fingers ability to bend properly. Finally, there is the option of a joint fusion. This is generally only necessary if all other options have been exhausted. The PIP joint is fused together to ease pain and inflammation, but full use is never restored to the finger.

How can Dr. Knight help you with a Swan Neck deformity?

Whether as a result of trauma or Rheumatoid arthritis, Swan Neck deformity of the fingers can be a debilitating and painful condition. Over his many years of practice, Dr. Knight has acquired an extensive knowledge of these finger-specific ailments and he understands how important it is to reduce their effects, so as to allow you to return to your life, and your work.

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