- See:
- Phalangeal Injury
- Finger Swan Neck Deformity
- Discussion:
- this deformity is more common in OA than in RA;
- deformity results from CMC joint dz (where as boutonniere deformity is mainly at MCP joint);
- result is erosion of articular surfaces & stretching of joint capsule;
- causes dorsal & radial subluxation of CMC joint;
- causes adduction contracture of metacarpal;
- hyperextension of MP joint & flexion deformity of IP joint;
- Treatment:
- conservative management includes splinting;
- hemiarthroplasty of CMC joint may be used for early disease;
- arthrodesis of MCP joint;
- volar capsulodesis in a position of flexion;
- complete replacement of trapezium in RA patient has high rate of dislocation;
- Swan Neck Staging:
- stage I:
- minimal CMC deformity w/o MP involvement
- consider splinting and CMC hemiarthroplasty
- stage II:
- CMC disease and correctable MP deformity
- CMC hemi arthroplasty
- MP tenodesis or fusion
- stage III:
- CMC dislocation w/ fixed MP deformity & fixed metacarpal adduction;
- CMC hemiarthroplasty, MP fusion, and 1st web space release