- Volar plate injury
- Duck bill deformity
- Recurvatum deformity
- 736.22 Swan-neck deformity
- M20.03 Swan-neck deformity
- M20.031 Swan-neck deformity of right finger(s)
- M20.032 Swan-neck deformity of left finger(s)
- M20.039 Swan-neck deformity of unspecified finger(s)
- Injury or loosening of the volar plate (ligament connecting proximal and middle phalanx that prevents hyperextension of the PIP)
- Hyperextension of the proximal interphalangeal joint (PIP) and flexion of the distal interphalangeal joint (DIP)
- Duck bill deformity is the same issue in the thumb less one joint
- Rheumatoid arthritis (RA)—most common cause of swan neck deformity
- Chronic inflammation loosens the volar plate, making PIP susceptible to hyperextension
- As a result, extensor tendon tightens causing DIP to pull into flexed position
- Swan neck classification4
- I: PIP joint flexible in all positions
- II: PIP motion limited only by tenodesis effect
- III: fixed PIP joint contracture, x-ray okay
- IV: x-ray shows arthritic changes
- Pain and swelling of the PIP
- Can be managed surgically or non-surgically depending upon signs and symptom severity, response to conservative treatment, and orthopedic physician recommendations
- Other causes include trauma, nerve injury such as cerebral palsy, Parkinson’s disease, or stroke.
- 50% of population with RA4
- Associated with population with neurological disorders (cerebral palsy, Parkinson’s disease, CVA)
- Pain and swelling of the PIP joint
- Laxity of the volar plate
- Snapping and locking of the fingers
- Hyperextension of the PIP and flexion of the DIP
- Difficulty and or pain with opening and closing hand in preparation for grasping or reaching
- Difficulty and/or pain with grasping dishes, utensils, or drinking cups due to pain and weakness
- Difficulty and/or pain with grasping and turning steering wheel
- Difficulty and/or pain with turning doorknob
Possible Contributing Causes
- Rheumatoid arthritis, or other rheumatic or connective tissue disorders
- Neurological disorders
- Cerebral palsy
- Parkinson’s disease
- Ehlers-Danlos syndrome
- Untreated mallet finger
- Overuse of the hand and fingers
- Ganglion of tendon sheath
- Dupuytren disease
- Loose body in the MCP joint
- Subluxation of the extensor digitorum communis
- X-ray to rule out fracture.
- Surgical options possible after failed conservative care
- Soft tissue repair
- PIP arthroplasty (PIP replaced with metal implant)
- Interphalangeal arthrodesis
- Radiologist for imaging, x-ray to rule out other pathology
- Primary care to rule our rheumatic causes or other connective tissue disorders
- Orthopedist for corticosteroid injections or surgical ...
Log In to View More
If you don't have a subscription, please view our individual subscription options below to find out how you can gain access to this content.
Want remote access to your institution's subscription?
Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.
If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.
AccessPhysiotherapy Full Site: One-Year Subscription
Connect to the full suite of AccessPhysiotherapy content and resources including interactive NPTE review, more than 500 videos, Anatomy & Physiology Revealed, 20+ leading textbooks, and more.
Pay Per View: Timed Access to all of AccessPhysiotherapy
24 Hour Subscription $34.95
48 Hour Subscription $54.95
Pop-up div Successfully Displayed
This div only appears when the trigger link is hovered over.
Otherwise it is hidden from view.