From the Research
The most effective treatment for swan neck deformity is surgical intervention, specifically spiral oblique retinacular ligament reconstruction using lateral band technique, as it provides good outcomes and stability of both PIP and DIP joints. Swan neck deformity is a finger condition characterized by hyperextension of the proximal interphalangeal (PIP) joint and flexion of the distal interphalangeal (DIP) joint, giving the finger a distinctive swan neck-like appearance. It commonly occurs in rheumatoid arthritis but can also result from trauma, stroke, cerebral palsy, or other conditions affecting hand function.
Causes and Symptoms
- The condition can result from various causes, including rheumatoid arthritis, trauma, and other conditions affecting hand function 1, 2.
- Symptoms include hyperextension of the PIP joint and flexion of the DIP joint, leading to a distinctive swan neck-like appearance.
Treatment Options
- For mild cases, conservative approaches include splinting to prevent PIP hyperextension while allowing functional finger movement, as well as physical therapy exercises to strengthen finger muscles and improve joint stability 3, 4.
- In moderate cases, silver ring splints or custom orthotic devices can provide support while maintaining hand function.
- For severe or fixed deformities, surgical intervention may be necessary, including tendon transfers, joint fusions, or arthroplasty, with spiral oblique retinacular ligament reconstruction using lateral band technique being a good choice for treating swan neck deformity 5.
Surgical Intervention
- Surgical intervention can provide good outcomes and stability of both PIP and DIP joints, with a study showing good results using spiral oblique retinacular ligament reconstruction using lateral band technique 5.
- The procedure involves reconstructing the spiral oblique retinacular ligament using the lateral band technique, which provides a dynamic tenodesis effect and improves stability of both DIP and PIP joints.
Importance of Early Treatment
- Early treatment is crucial to prevent permanent deformity, as the condition can progress from a flexible deformity (which can be passively corrected) to a fixed deformity 1, 2.
- The underlying mechanism involves imbalance in the extensor mechanism of the finger, often beginning with weakening of the volar plate at the PIP joint, allowing the joint to hyperextend while the lateral bands of the extensor tendon shift dorsally, pulling the DIP joint into flexion.