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Swan-Neck Deformity

by David R. Steinberg, MD

Swan-neck deformity is a bending in (flexion) of the base of the finger, a straightening out (extension) of the middle joint, and a bending in of the outermost joint.

The most common cause is rheumatoid arthritis. Other causes include untreated mallet finger, looseness (laxity) of the fibrous plate inside the hand at the base of the fingers or of the finger ligaments, chronic muscle spasm affecting the hands caused by nerve damage (called muscle spasticity), other types of arthritis, a ruptured finger tendon, and misalignment in the healing of a fracture of the middle bone of the finger. Normal bending of the finger may become impossible. The deformity can therefore result in considerable disability.

When the Fingers Are Abnormally Bent

Some disorders, such as rheumatoid arthritis, and injuries can cause the fingers to bend abnormally. In swan-neck deformity, the joint at the base of the finger bends in (flexes), the middle joint straightens out (extends), and the outermost joint bends in. In boutonnière deformity, the middle finger joint is bent inward (toward the palm), and the outermost finger joint is bent outward (away from the palm).

True swan-neck deformity does not affect the thumb, which has one less joint than the other fingers. However, in a variant of swan-neck deformity, called duck-bill, Z (zigzag) type, or 90°-angle deformity, the top joint of the thumb is severely overstraightened with a bending in of the joint at the base of the thumb to form a 90° angle. If duck-bill deformity and swan-neck deformity of one or more fingers occur together, the ability to pinch can be seriously reduced.

A doctor makes the diagnosis by examining the hand and finger.

Treatment

Treatment is aimed at correcting the underlying disorder when possible. Mild deformities that have not yet developed scarring may be treated with finger splints (ring splints), which correct the deformity while still allowing a person to use the hand. Problems with the ability to pinch can be greatly improved by surgically realigning the joints or by fusing the thumb or finger joints together (called interphalangeal arthrodesis) into positions that allow for optimal function.

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