Swan Neck Deformity: Diagnosis, Treatment, and Rehabilitation at Palms Physiotherapy & Allied Health

What is Swan Neck Deformity?

Swan neck deformity occurs when the proximal interphalangeal joint (PIP) of the finger becomes hyperextended, and the distal interphalangeal joint (DIP) is flexed, creating a characteristic "swan neck" appearance. This deformity results from ligament or tendon damage, which causes imbalances in the extensor and flexor muscles of the finger. In some cases, the deformity can be caused by conditions such as rheumatoid arthritis, finger injuries, tendon ruptures, or genetic conditions affecting connective tissue.

Common Causes of Swan Neck Deformity

The primary causes of Swan Neck Deformity include:

• Rheumatoid arthritis (RA), where inflammation damages the ligaments and tendons.

• Tendon injuries affecting the flexor tendons, particularly when the central slip is ruptured.

• Finger fractures, especially those that affect the PIP joint.

• Genetic conditions that affect connective tissue, such as Ehlers-Danlos syndrome.

• Traumatic injuries that cause damage to the joint or tendons, leading to abnormal tension.

Symptoms of Swan Neck Deformity

Swan Neck Deformity typically presents with several symptoms, which can range from mild to severe, depending on the extent of the injury or the underlying condition. Common symptoms include:

1. Hyperextension of the Proximal Joint (PIP)

• The PIP joint becomes hyperextended, or bent backward, making the finger appear out of alignment.

2. Flexion of the Distal Joint (DIP)

• The DIP joint appears flexed, or bent forward, contributing to the characteristic "swan neck" look of the finger.

3. Pain and Swelling

• Pain and swelling around the affected joints, particularly after prolonged use or in cases of flare-ups (e.g., in rheumatoid arthritis).

4. Stiffness and Limited Range of Motion

• The affected finger may experience stiffness and a limited range of motion, making it difficult to fully straighten or bend the finger.

5. Weakness and Reduced Function

• There may be a weak grip or difficulty performing tasks that require finger dexterity, such as writing, typing, or holding objects.

Causes of Swan Neck Deformity

The primary cause of Swan Neck Deformity is damage to the ligaments, tendons, or the joint capsule that stabilize the finger. Some of the leading causes include:

1. Rheumatoid Arthritis

• Rheumatoid arthritis (RA) is a common cause of Swan Neck Deformity, as the inflammation in the joints can damage the ligaments and tendons responsible for proper finger alignment.

2. Tendon Injuries

• Injuries to the extensor tendons or flexor tendons of the finger can result in a malfunction of the finger joints, leading to deformities such as Swan Neck.

3. Fractures

• A fracture in the PIP joint can disrupt the alignment of the finger and cause tendon or ligament damage that leads to Swan Neck Deformity.

4. Genetic Conditions

• Conditions like Ehlers-Danlos syndrome, which affect connective tissues, can contribute to hyperextensibility of the joints, making individuals more prone to developing Swan Neck Deformity.

5. Trauma or Finger Strain

• Direct trauma to the finger, such as a dislocation, sprain, or repetitive strain injuries, can cause damage to the joint or tendons, contributing to the development of Swan Neck Deformity.

Diagnosis of Swan Neck Deformity

At Palms Physiotherapy & Allied Health, accurate diagnosis is key to managing Swan Neck Deformity effectively. Diagnosis typically includes:

1. Physical Examination

• Our healthcare providers will conduct a thorough physical exam to evaluate the alignment of the affected finger joints. They will also check for pain, swelling, and restricted motion in the finger.

2. X-Ray Imaging

• X-rays may be required to check for any underlying fractures or joint damage that could be contributing to the deformity.

3. Ultrasound or MRI (if needed)

• Ultrasound or MRI imaging may be used to assess damage to the ligaments or tendons around the finger joints.

Treatment Options for Swan Neck Deformity at Palms Physiotherapy & Allied Health

The treatment for Swan Neck Deformity depends on the severity of the deformity and the underlying cause. Treatment options may include:

1. Splinting and Immobilization

• A splint is typically used to immobilize the affected finger joint and prevent hyperextension of the PIP joint. The splint is usually worn for several weeks to allow healing of the tendons and ligaments.

2. Pain Management

• Medications such as NSAIDs (nonsteroidal anti-inflammatory drugs) or paracetamol can help manage pain and swelling associated with Swan Neck Deformity.

3. Physiotherapy and Rehabilitation

• Physiotherapy plays a central role in treating Swan Neck Deformity. After immobilization, rehabilitation will focus on:

  • Finger stretching exercises to regain flexibility and mobility in the joints.

  • Strengthening exercises to restore strength to the flexor and extensor tendons.

  • Joint protection techniques to reduce stress on the finger joints and prevent further damage.

  • Functional exercises to improve grip strength and dexterity, making everyday tasks easier.

4. Corticosteroid Injections

• In cases where rheumatoid arthritis is the cause of the deformity, corticosteroid injections into the joint can help reduce inflammation and relieve symptoms.

5. Surgical Treatment (for Severe Cases)

• In more severe or chronic cases, surgery may be required to correct the deformity. Surgical options may include:

  • Tendon repair or reconstruction to restore the balance between flexor and extensor tendons.

  • Joint fusion (arthrodesis) or joint replacement for patients with severe joint damage or arthritis.

Recovery and Rehabilitation

The recovery process for Swan Neck Deformity depends on the severity of the deformity and the type of treatment used. Generally, recovery includes:

1. Post-Splinting Rehabilitation

• After the splinting phase, rehabilitation will focus on restoring range of motion, strength, and finger functionality. Therapy may last several weeks to months, depending on the individual's condition.

2. Long-Term Management

• Regular follow-up appointments and therapy sessions are crucial to monitor progress and prevent the recurrence of the deformity. Strengthening and flexibility exercises will be important to ensure the joints and tendons remain functional.

Conclusion

Swan Neck Deformity can significantly impact hand function, but with appropriate treatment and rehabilitation, many individuals can regain full or partial function of their finger. At Palms Physiotherapy & Allied Health, we offer expert care and rehabilitation programs tailored to your needs, helping you recover and manage your symptoms. Whether caused by arthritis, injury, or other underlying conditions, we can work with you to develop a personalized treatment plan to improve your quality of life.