Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ Volar plate injuryDuck bill deformityRecurvatum deformity ++ 736.22 Swan-neck deformity ++ M20.03 Swan-neck deformityM20.031 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) ++ 4D: Impaired joint mobility, motor function, muscle performance, and range of motion associated with connective tissue dysfunction +++ Description ++ 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 +++ Essentials of Diagnosis ++ Rheumatoid arthritis (RA)—most common cause of swan neck deformityChronic inflammation loosens the volar plate, making PIP susceptible to hyperextensionAs a result, extensor tendon tightens causing DIP to pull into flexed positionSwan neck classification4I: PIP joint flexible in all positionsII: PIP motion limited only by tenodesis effectIII: fixed PIP joint contracture, x-ray okayIV: x-ray shows arthritic changes +++ General Considerations ++ Pain and swelling of the PIPCan be managed surgically or non-surgically depending upon signs and symptom severity, response to conservative treatment, and orthopedic physician recommendationsOther causes include trauma, nerve injury such as cerebral palsy, Parkinson’s disease, or stroke. +++ Demographics ++ Adults50% of population with RA4Associated with population with neurological disorders (cerebral palsy, Parkinson’s disease, CVA) +++ Signs and Symptoms ++ Pain and swelling of the PIP jointLaxity of the volar plateSnapping and locking of the fingersHyperextension of the PIP and flexion of the DIP +++ Functional Implications ++ Difficulty and or pain with opening and closing hand in preparation for grasping or reachingDifficulty and/or pain with grasping dishes, utensils, or drinking cups due to pain and weaknessDifficulty and/or pain with grasping and turning steering wheelDifficulty and/or pain with turning doorknob +++ Possible Contributing Causes ++ TraumaRheumatoid arthritis, or other rheumatic or connective tissue disordersNeurological disordersCerebral palsyParkinson’s diseaseEhlers-Danlos syndromeUntreated mallet fingerOveruse of the hand and fingers +++ Differential Diagnosis ++ Ganglion of tendon sheathDupuytren diseaseLoose body in the MCP jointSubluxation of the extensor digitorum communis +++ Imaging ++ X-ray to rule out fracture. +++ Medication ++ NSAIDs +++ Medical Procedures ++ Surgical options possible after failed conservative careSoft tissue repairPIP arthroplasty (PIP replaced with metal implant)Interphalangeal arthrodesis ++ Radiologist for imaging, x-ray to rule out other pathologyPrimary care to rule our rheumatic causes ... Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth