From the Guidelines
Swan neck deformity can occur in osteoarthritis (OA), although it is less common than in inflammatory arthritis conditions like rheumatoid arthritis. In osteoarthritis, this deformity typically develops as a secondary consequence of joint damage and biomechanical changes. Swan neck deformity presents as hyperextension of the proximal interphalangeal (PIP) joint with flexion of the distal interphalangeal (DIP) joint. In OA, it usually results from cartilage loss, joint instability, and altered tendon mechanics that develop over time. The deformity often begins with DIP joint OA, which causes compensatory changes in finger biomechanics, eventually leading to PIP hyperextension.
According to the 2019 American College of Rheumatology/Athritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee 1, management of OA includes exercise, weight loss, self-efficacy and self-management programs, and the use of hand orthoses for first carpometacarpal (CMC) joint OA. While this guideline does not specifically address swan neck deformity, it highlights the importance of orthotic devices in managing OA-related deformities.
Some key points to consider in the management of swan neck deformity in OA include:
- Splinting to prevent progression of the deformity
- Hand therapy to maintain function and range of motion
- Pain control with acetaminophen or NSAIDs
- In severe cases, surgical interventions like joint fusion or arthroplasty may be necessary
- Early intervention is crucial, as established deformities can become increasingly difficult to correct and significantly impact hand function and quality of life.
It's worth noting that the evidence for managing swan neck deformity in OA is largely based on expert opinion and lower-level studies, such as the 2007 EULAR evidence-based recommendations for the management of hand osteoarthritis 1. However, the 2020 guideline from the American College of Rheumatology/Athritis Foundation 1 provides more recent and higher-quality evidence for the management of OA in general, which can be applied to the management of swan neck deformity in OA.
From the Research
Swan Neck Deformity in Osteoarthritis
- Swan neck deformity can occur due to various conditions, including osteoarthritis (OA) 2, 3.
- Osteoarthritis is mentioned as a potential cause of swan neck thumb deformity in a study published in 2012 2.
- Another study from 2018 describes seven cases of swan neck deformity resulting from chronic radial collateral ligament injury of the little finger proximal interphalangeal joint, with all patients having osteoarthritis and ulnar deviation of the PIP joints 3.
- The studies suggest that swan neck deformity can be associated with osteoarthritis, particularly in the context of thumb deformities or radial collateral ligament injuries.
Characteristics and Treatment
- Swan neck deformity in osteoarthritis may present with hyperextension and ulnar deviation of the proximal interphalangeal joint, as well as painful snapping of the joint 3.
- Treatment options for swan neck deformity in osteoarthritis may include surgical reconstruction of the palmar plate and radial collateral ligament, as well as tenodesis of the proximal interphalangeal joint 3, 4.
- The choice of treatment depends on the severity and flexibility of the deformity, as well as the overall medical status of the patient 5.