eMedicine Specialties > Orthopedic Surgery > Hand & Upper Extremity

Swan-Neck Deformity: Follow-up

Author: Roberto Sandoval, MD, Consulting Staff, Department of Emergency Medicine, Anaheim Memorial Medical Center, La Palma Intercommunity Hospital
Coauthor(s): John A Kare, MD, Assistant Professor of Emergency Medicine, Charles R Drew University of Medicine and Science/UCLA, Director of Research, Department of Emergency Medicine, Martin Luther King Jr/Charles R Drew Medical Center; Eleby R Washington III, MD, FACS, Associate Professor, Department of Surgery, Division of Orthopedics, Charles R Drew University of Medicine and Science; Roman V Voytsekhovskiy, MD, Fellow in Hand Surgery, Department of Orthopedic Surgery, Rush University Medical Center; Robert R Schenck, MD, Associate Professor, Departments of Plastic and Orthopedic Surgery, Rush Medical College; Director, Section of Hand Surgery, Department of Plastic and Orthopedic Surgery, Rush University Medical Center
Contributor Information and Disclosures

Updated: Nov 2, 2007

Outcome and Prognosis

Early swan-neck deformity can be corrected by intrinsic release, flexor synovectomy, the correction of PIP joint hyperextension with capsulodesis or tenodesis, or a combination thereof.

Patients have reported significant pain relief after PIP joint synovectomy. At 5-year follow-up, 60% of patients who underwent PIP joint synovectomy maintained their improved grip strength.

Soft-tissue reconstruction is not advisable in cases of advanced swan-neck deformity if lateral instability exists or if the patient has suffered articular changes or joint destruction.

Kiefhaber and Strickland were disappointed in the results of soft-tissue reconstruction of boutonni è re and swan-neck deformities.4 They recommended arthrodesis for most PIP joints with significant extensor deficit and for all rigid boutonniere deformities. (See also the eMedicine article Boutonniere Deformity.)

Future and Controversies

As with many hand problems, the treatment for swan-neck deformity is much more likely to be successful if it is implemented early in the course of the deformity. If there is not timely referral to a hand surgeon, the resultant function of the hand may be severely compromised. It is important, therefore, that a correct diagnosis of RA is made, that medical treatment is instituted, and that hand surgery evaluation is performed before severe and possibly permanent deformities occur.

It is the responsibility of the emergency physician to be cognizant of the treatments available for swan-neck deformity and to work closely with the patient in obtaining an early referral to a hand surgeon.

 


More on Swan-Neck Deformity

Overview: Swan-Neck Deformity
Workup: Swan-Neck Deformity
Treatment: Swan-Neck Deformity
Follow-up: Swan-Neck Deformity
References
[ CLOSE WINDOW ]

References

  1. Nalebuff EA. The rheumatoid swan-neck deformity. Hand Clin. May 1989;5(2):203-14. [Medline].

  2. Welsh RP, Hastings DE. Swan neck deformity in rheumatoid arthritis of the hand. Hand. Jun 1977;9(2):109-16. [Medline].

  3. Bickel KD. The dorsal approach to silicone implant arthroplasty of the proximal interphalangeal joint. J Hand Surg [Am]. Jul-Aug 2007;32(6):909-13. [Medline].

  4. Kiefhaber TR, Strickland JW. Soft tissue reconstruction for rheumatoid swan-neck and boutonniere deformities: long-term results. J Hand Surg [Am]. Nov 1993;18(6):984-9. [Medline].

  5. Aronowitz ER, Leddy JP. Closed tendon injuries of the hand and wrist in athletes. Clin Sports Med. Jul 1998;17(3):449-67. [Medline].

  6. Dearborn JT, Jergesen HE. The evaluation and initial management of arthritis. Prim Care. Jun 1996;23(2):215-40. [Medline].

  7. Gainor BJ, Hummel GL. Correction of rheumatoid swan-neck deformity by lateral band mobilization. J Hand Surg [Am]. May 1985;10(3):370-6. [Medline].

  8. Harrison BP, Hilliard MW. Emergency department evaluation and treatment of hand injuries. Emerg Med Clin North Am. Nov 1999;17(4):793-822, v. [Medline].

  9. Lee SJ, Montgomery K. Athletic hand injuries. Orthop Clin North Am. Jul 2002;33(3):547-54. [Medline].

  10. Littler JW. The digital extensor-flexor system. In: Converse JM, ed. Reconstructive Plastic Surgery: Principles and Procedures in Correction, Reconstruction, and Transplantation. 2nd ed. Philadelphia, Pa: WB Saunders; 1977:6.

  11. Nalebuff EA, Millender LH. Surgical treatment of the swan-neck deformity in rheumatoid arthritis. Orthop Clin North Am. Jul 1975;6(3):733-52. [Medline].

  12. Norris ME 3rd, Samra S, DeMercurio J, et al. Free palmaris longus graft tenodesis effectively treats swan neck adduction collapse secondary to thumb basilar joint arthritis. Plast Reconstr Surg. Aug 2007;120(2):475-81. [Medline].

  13. O'Brien ET. Surgical principles and planning for the rheumatoid hand and wrist. Clin Plast Surg. Jul 1996;23(3):407-20. [Medline].

  14. Perron AD, Brady WJ, Keats TE. Orthopedic pitfalls in the emergency department: closed tendon injuries of the hand. Am J Emerg Med. Jan 2001;19(1):76-80. [Medline].

  15. Rosen A, Weiland AJ. Rheumatoid arthritis of the wrist and hand. Rheum Dis Clin North Am. Feb 1998;24(1):101-28. [Medline].

  16. Smrcka V, Dylevsky I. Treatment of congenital swan neck deformity with dynamic tenodesis of proximal interphalangeal joint. J Hand Surg [Br]. Apr 2001;26(2):165-7. [Medline].

  17. Thompson JS, Littler JW, Upton J. The spiral oblique retinacular ligament (SORL). J Hand Surg [Am]. Sep 1978;3(5):482-7. [Medline].

  18. Tuttle HG, Olvey SP, Stern PJ. Tendon avulsion injuries of the distal phalanx. Clin Orthop Relat Res. Apr 2006;445:157-68. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

volar plate synovitis, synovitis of capsule, collateral ligament synovitis, finger deformity, arthritis, rheumatoid arthritis, hand deformity, finger deformity, rheumatoid factor, rheumatoid hand, RA, tenosynovitis, swan neck deformity, boutonniere deformity

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Roberto Sandoval, MD, Consulting Staff, Department of Emergency Medicine, Anaheim Memorial Medical Center, La Palma Intercommunity Hospital
Roberto Sandoval, MD is a member of the following medical societies: American College of Emergency Physicians and American Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

John A Kare, MD, Assistant Professor of Emergency Medicine, Charles R Drew University of Medicine and Science/UCLA, Director of Research, Department of Emergency Medicine, Martin Luther King Jr/Charles R Drew Medical Center
John A Kare, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Medical Student Association/Foundation, and Emergency Medicine Residents Association
Disclosure: Nothing to disclose.

Eleby R Washington III, MD, FACS, Associate Professor, Department of Surgery, Division of Orthopedics, Charles R Drew University of Medicine and Science
Eleby R Washington III, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Medical Association, International College of Surgeons, and National Medical Association
Disclosure: Nothing to disclose.

Roman V Voytsekhovskiy, MD, Fellow in Hand Surgery, Department of Orthopedic Surgery, Rush University Medical Center
Disclosure: Nothing to disclose.

Robert R Schenck, MD, Associate Professor, Departments of Plastic and Orthopedic Surgery, Rush Medical College; Director, Section of Hand Surgery, Department of Plastic and Orthopedic Surgery, Rush University Medical Center
Robert R Schenck, MD is a member of the following medical societies: American Association for Hand Surgery, American College of Surgeons, American Medical Association, American Society for Surgery of the Hand, American Society of Plastic Surgeons, American Society of Reconstructive Microsurgery, Chicago Medical Society, and Illinois State Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Joseph E Sheppard, MD, Director of Hand and Upper Extremity, Associate Professor, Department of Orthopedic Surgery, University of Arizona
Joseph E Sheppard, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, American Society for Surgery of the Hand, Southern Orthopaedic Association, and Western Orthopaedic Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Robert J Nowinski, DO, Clinical Assistant Professor of Orthopaedic Surgery, Ohio University College of Osteopathic Medicine; Private Practice, Orthopedic Specialists and Sports Medicine, Newark, Ohio
Robert J Nowinski, DO is a member of the following medical societies: American Medical Association and American Osteopathic Association
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD, Consulting Surgeon, Broward Hand Center, Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami School of Medicine
Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, and Arkansas Medical Society
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.