Rheumatoid Hand: Swan-Neck Deformity


Swan-neck deformity, characterized by proximal interphalangeal (PIP) joint hyperextension, distal interphalangeal (DIP) joint flexion, volar plate incompetence, and dorsal laxity of the lateral bands, is common in patients with rheumatoid arthritis. The deformity is the end result of synovitis of the joints, tendon sheaths, and ligaments, which disrupts the balance of flexion and extension forces across a joint and results in deformity, weakness, and loss of function. Management of swan-neck deformity is based on the flexibility of the PIP joint, integrity of the articular cartilage, and functional level of the patient. Nonsurgical treatment for swan-neck deformity, including extension block splinting, is considered for patients with preserved function. Surgical management involves procedures that limit PIP joint hyperextension and restore DIP joint extension, including DIP joint arthrodesis, tenodesis of the flexor digitorum superficialis, reconstruction of the oblique retinacular ligament, volar PIP joint dermodesis, and lateral band translocation. In late-stage disease, soft-tissue procedures alone may not result in lasting correction of deformity.

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