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Swan Neck Deformity - Finger Deformity

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Introduction

A swan neck deformity occurs when the structures that keep the middle joint of your finger from bending back too far are injured, stretched or weakened. The injury causes the middle finger (proximal interphalangeal) joint to hyperextend. This situation causes an disturbance in the tendon system causing the end finger (distal interphalangeal) joint to bend (flex). This makes the finger appear crooked.

A swan neck deformity can cause pain and loss of function. It is most commonly caused by rheumatoid arthritis. Treatments include splinting, hand therapy, and surgery.
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Anatomy

Your fingers are made up of three bones called phalanges. Two joints separate the phalanges. The distal interphalangeal (DIP) joints are located near your fingertips. The proximal interphalangeal (PIP) joints are located in the middle of your fingers.

The extensor tendons attach to your phalanges and allow your fingers to extend (straighten). Ligaments attach your bones to each other. The volar plate is a strong fibrous structure located on the palm side of the PIP joint. It functions to prevent hyperextension of your PIP joint.
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Causes

A swan neck deformity occurs when the volar plate becomes torn, weakened, loose, or stretched. When the volar plate is affected, the PIP joint bends back too far and hyperextends. This causes the DIP joint to bend towards the palm of the hand in flexion. The result is a crooked finger with the characteristic swan neck deformity.

Chronic inflammation from rheumatoid arthritis is the most common cause of swan neck deformity. Trauma or neurological conditions, such as cerebral palsy, stroke, Parkinson’s disease, and traumatic brain injury, can cause finger muscles to tighten and stretch the volar plate.
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Symptoms

A swan neck deformity can cause your finger joints to feel painful and swollen. Your PIP joint will bend back too far in hyperextension and your DIP joint will bend in towards the palm of your hand. Finger function can be affected when the deformity is not flexible. Your finger will look crooked.
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Diagnosis

Your doctor can diagnose a swan neck deformity by examining your hand. X-rays will be taken to show joint alignment, joint damage, and to rule out fractures.
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Treatment

Some swan neck deformities can be treated with splinting and hand therapy. This works bests for finger joints that are flexible and not stiff. A hand therapist will show you exercises to stretch and strengthen your joints to gain function. Splinting is usually tried for at least six weeks.
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Surgery

Surgery may be necessary to reconstruct the skin, tendons, and ligaments that support the PIP joint. If the PIP joint is very damaged, an artificial joint may be surgically implanted to help restore movement, along with proper tendon balancing. This procedure is called Arthroplasty. In some cases, the bones in the finger may be surgically fused together and kept from moving. All types of surgery are followed by splinting and hand therapy rehabilitation.
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Recovery

A full recovery from swan neck deformity surgery can take up to six months. Recovery times for nonsurgical treatments can be from 8 to 12 weeks. Recovery is individualized and your doctor will let you know what to expect.
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Prevention

You should contact your doctor if you notice that you are developing a swan neck deformity. In many cases, early treatment is associated with the best outcomes. Following treatment, your hand therapist can recommend ways to perform your regular activities to help you avoid future injuries. You should participate in your home exercise program and wear your splint as instructed.
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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on February 16, 2022. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.

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Dr. Reznick did major surgery on my right hand (carpal tunnel and 3 trigger fingers). Prior to the surgery, I could not hold a pen or write my name legibly. I was in constant pain. After the surgery, while the stitches were still in and the brace still in place, I had more flexibility in my fingers than I had before the surgery. I am six weeks out from the surgery and I continue to progress. I have more functionality and strength in my hand than I have had in the last year. I can't even see the scars on my hand. Dr. Reznick not only did a spectacular job of restoring the use of my hand, but she is a very likable person. Her staff is friendly and professional. I cannot say enough good things about this experience!

Nancy L.

via md.com

Seeing Dr. Reznick and being treated by her is like going to heaven with millions of angels. She can not only treat your hand, she treats the soul. She is the best!!!

Les D.

via healthgrades.com

Amazing visit. I can't remember the last time I spent quality time with a doctor. She explained everything to me on why I was having trigger finger issues. I have been dealing with this for some time. She nailed it on the first visit ‘cause she talks to you and listens! If you need a hand doctor you will be happy she is the one.

Anonymous

via healthgrades.com

Dr. Reznick is one of the most professional, sensitive and caring physicians I have visited. She is a teacher--patient and informative, and she made sure I understood just exactly what was necessary for my particular problems. She took care of both my left and right carpal tunnel surgeries, and I couldn't have asked for a better recovery. Everything went just as planned. She is my ‘go to’ hand doctor!

Anonymous

healthgrades.com

When I was having problems with my wrist, she guided me through every step, and always made sure I was comfortable with what she was doing. Very straightforward and trustworthy. I never doubted what she was doing and she always wants to try every technique before doing surgery to try to make you better.

Shannon C.

healthgrades.com

I recently rode 900 miles on a vibrating Harley-Davidson and did not have a single tingle in either of my hands. You do great work. Thanks for helping me.

Ed G.

Just wanted to let you know again how much I appreciated your care, expertise and skill in conducting the surgery on my hand. A job well done. Thank you.

Randall A.

My surgery went very well. My banjo and I thank you.

Kevin M.

Dr. Lisa Reznick has performed carpal tunnel surgery on both hands and has removed my basal joint from my right hand. All of my surgeries have been successful, and I now have complete use of both hands and my right thumb, which I credit to a great surgeon, good therapy, and a genuine concern for patients.

Robert

My hand is in perfect working order because of your expertise. I appreciate your genuine concern for my healing. Through the myriad of maladies my husband experienced, I became acquainted with many doctors. None even approached your level of patient care.

Trudy R.

Dr. Reznick performed surgery on my hand for ‘trigger finger’ and did a wonderful job. I’ll definitely user her again if the need ever presents itself again.

Don L.

Dr. Reznick is very to the point and no nonsense. She tells you what options there are in your treatment and advises you accordingly. I had hand surgery four years ago and it was a complete success. I actually went back to work one week early. I have recommended Dr. Reznick to many friends and associates. Frankly, I won’t go to anyone else when it comes to muscles or bones. I have complete faith in her.

J. Schully

via vitals.com

Dr. Reznick did major surgery on my right hand (carpal tunnel and 3 trigger fingers). Prior to the surgery, I could not hold a pen or write my name legibly. I was in constant pain. [Now] I have more functionality and strength in my hand than I have had in the last year. I can't even see the scars on my hand. Dr. Reznick not only did a spectacular job of restoring the use of my hand, but she is a very likable person. Her staff is friendly and professional. I cannot say enough good things about this experience!

~ Nancy L. via md.com

Lisa R. Reznick MD, PA

Board Certified Orthopedic and Hand Surgeon

4100 Fairway Court, Suite 120
Carrollton, TX 75010
Phone: (972) 395-9000
Fax: (972) 395-9002

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In Carrollton, TX, board-certified orthopedic surgeon Dr. Lisa Reznick offers conservative treatment options for all types of general orthopedic issues, while specializing in surgeries of the hand, wrist, and elbow.