Swan neck deformity

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

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Overview

A swan-neck deformity, typically defined as proximal interphalangeal joint (PIP) hyperextension with concurrent distal interphalangeal joint flexion, occurs in approximately 50% of patients with Rheumatoid Arthritis.

This deformity is not unique to Rheumatoid Arthritis, because it may also be congenital or traumatic in nature. Multiple surgical procedures are available for the correction of this digital abnormality. The deformity of the finger or fingers must be staged accurately to use the most appropriate surgical technique. The staging of the deformed finger is based on the condition of the articular cartilage (determined by radiography) and on the flexibility of the proximal interphalangeal joint.

Classification

Welsh and Hastings classified swan-neck deformity as mobile, snapping, or fixed, on the basis of the condition of the digital intrinsic muscles and subdivided swan neck deformity into 2 types:[1]

Nalebuff classifies swan-neck deformities into 4 types: [2]

The Nalebuff classification guides in the choice of surgical treatment for swan neck deformity, and became the more widely accepted one.

Diagnosis

Swan-neck deformity is common in persons with Rheumatoid Arthritis. It occurs as the end result of rheumatoid synovitis of the metacarpophalangeal joint (MP), proximal interphalangeal joint, and/or distal interphalangeal joints, which disrupts the balance of flexion and extension forces acting across a joint.

Swan Neck Deformity[3]

References

  1. Welsh RP, Hastings DE. Swan neck deformity in rheumatoid arthritis of the hand. Hand. Jun 1977;9(2):109-16.
  2. Nalebuff EA. The rheumatoid swan-neck deformity. Hand Clin. May 1989;5(2):203-14
  3. Phadke S.R Indian Pediatrics 2002; 39:400


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