Swan Neck Deformity
Swan Neck Side View
This ring finger has a swan neck deformity in which the middle joint is hyperextended and the distal joint is bent
Why does it occur?
Swan-neck deformity is hyper-extension of the middle joint (PIP) of the finger and flexion of the last joint (DIP). This deformity leads to an S-shaped finger resembling the shape of a swan’s neck. This can occur from trauma to the volar plate (a thick ligament on the palmar aspect of the finger) or secondary to a Mallet Finger. It can also occur from inflammatory disorders such as Rheumatoid Arthritis, where ligaments can become attenuated. In patients who have hypermobile joints (ligamentous laxity), a certain degree of Swan Neck deformity may actually be normal for them.
Patients initially present with the classic s-shaped finger deformity. A significant deformity may prevent patients from initiating the closing of the fingers. Patients often mention a “click” or “snap” of the affected finger when making a fist. This is due to disruption of the fingers normal anatomic alignment.
The diagnosis is usually made by physical exam. However, an x-ray is usually performed to rule out a fracture or avulsion injury to the bone, while an MRI may be considered to further assess the soft tissue structures.
Nonoperative Treatment Options:
Nonoperative treatment usually begins with consistently wearing a splint designed to correct the deformity. Patients will often remain in the splint for up to 6 weeks prior to starting occupational therapy to restore motion, strength and functionality. The success of this treatment hinges on having a compliant patient willing to wear the splint 24 hours a day.
Surgery is considered in patients who fail to improve with nonoperative treatment. Dr. Steven J. Lee has helped to revolutionize many aspects of hand surgery with his pioneering of Internal Brace technology. Application of this technology to Swan Neck deformities has similarly improved the technique and the outcomes, while speeding up the recovery process.
Patients will be transitioned into a custom splint at their first post-op appointment. With Internal Brace technology, patients can begin therapy a week after surgery (which would normally be between 4-6 weeks after surgery without Internal Brace technology). Therapy usually lasts about 6 weeks, Patients can expect relatively normal use and function of their hand about 6-8 weeks after surgery.
Immediate Post-Operative Instructions
Please refer to the following pages for more information:
*It is important to note that all of the information above is not specific to anyone and is subject to change based on many different factors including but not limited to individual patient, diagnosis, and treatment specific variables. It is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopedic advice or assistance should consult Dr. Steven Lee or an orthopedic specialist of your choice.
*Dr. Steven Lee is a board certified orthopedic surgeon and is double fellowship trained in the areas of Hand and Upper Extremity Surgery, and Sports Medicine. He has offices in New York City, Scarsdale, and Westbury Long Island.