Swan neck deformity is a chronic finger abnormality that looks like a crooked finger. It often stems from untreated mallet finger. Technically, a swan neck deformity occurs when the strongest ligament (the volar plate) in the middle joint of the finger (called the proximal interphalangeal joint or PIP joint) loosens from disease or injury. Many different causes contribute to swan neck deformity including rheumatoid arthritis (RA), stroke and nerve disorders such as Parkinson’s disease and cerebral palsy.
Symptoms and Diagnosis
Typically, Dr. Urbanosky is able to diagnose swan neck deformity from a thorough physical exam in which she looks for pain and swelling in the PIP joint and for a DIP joint that is bent down in flexion. The DIP joint is nearest the end of the finger (also called the distal interphalangeal joint). The PIP joint is the middle joint between the main knuckle and the DIP joint. She will also confirm the patient’s inability to wrap the fingers around the handle of any object. She may order an X-ray to assess joint alignment, joint surfaces and to look for fractures (bone breakage).
Treatment for swan neck deformity can be nonsurgical or surgical. Dr. Urbanosky will first assess whether the PIP joint is supple or stiff. In cases where the PIP joint is flexible, she will employ a non-operative approach with splinting, stretching, massage and joint mobilization to restore function.
Even in cases where the PIP joint is stiff, Dr. Urbanosky will often suggest splinting and exercise therapy to improve joint mobility before surgical treatment.
Surgical treatment options include:
Soft tissue repair
Early stages of swan neck deformity are often treated through soft tissue reconstruction surgery as well as joint manipulation. In soft tissue repair, Dr. Urbanosky releases, aligns and balances the soft tissues around the PIP joint. Because this surgery carries a high risk of failing to completely restore normal finger function, it is critical that patients seek the most experienced surgeon for this treatment. Dr. Urbanosky specializes in such surgeries and her vast experience makes for strong outcomes for her patients.
PIP Joint Arthroplasty
Later stages of swan neck deformity are often characterized by a stiff PIP joint. In these cases, Dr. Urbanosky often will employ arthroplasty, which is artificial joint replacement of the PIP joint. In this procedure, Dr. Urbanosky removes both surfaces of the PIP joint before installing the artificial implant.
Finger Joint Fusion
In cases where rheumatoid arthritis (RA) has caused the swan neck deformity and the PIP joint remains flexible, Dr. Urbanosky may suggest fusing the DIP joint to immobilize the mallet deformity [[link to mallet finger section]] in the DIP joint, reduce pain, stabilize the joint and prevent further deformity in the joint.
In cases where previous treatments and surgery fail to stop inflammation, Dr. Urbanosky might suggest fusing the PIP joint in a bent position.
If you think that you may be experiencing Swan Neck Deformity, contact Dr. Leah Urbanosky for a consultation: (815) 462-3474.
Cysts & Tumors
De Quervain's Tenosynovitis
Carpal Tunnel Syndrome
Traumatic Hand Injuries
Joint Replacement of the Hand
Mallet Finger (Baseball Finger)
Swan Neck Deformity
UCL Tear of the Thumb
Osteoarthritis of the Thumb