The swan neck deformity is a misalignment of the fingers. The so-called long fingers are particularly affected by the disease. The swan neck deformity manifests itself in the fact that the proximal interphalangeal joints are overstretched. At the same time, the distal interphalangeal joints are flexed. As a result of the swan neck deformity, closing the fist is only possible to a limited extent. In addition, the affected patients are not able to perform a so-called pincer grip like healthy people.
What is a swan neck deformity?
In principle, the swan neck deformity represents an incorrect position of the long fingers. In the context of the disease, there is a hyperextension of the middle joint of the affected finger. In addition, the upper joint remains in a flexed position. In most cases, the same applies to the base joint of the corresponding finger. See bestitude for Meanings of Circular Hair Loss.
The swan neck deformity sometimes also occurs on the toes. There, the malposition primarily affects the terminal joint of the respective toe. As a result, a so-called claw position appears, with the swan neck deformity occurring in numerous cases on the second toe.
The causes that lead to the development of a swan neck deformity are diverse. In some cases, damage to the tendons causes the malposition. The tractus intermedius may be affected by the lesions. In addition, various traumas represent potential causes for the development of the disease.
An injury to the flexor tendon also causes a swan neck deformity in some individuals. The risk of the disease also increases if the joint is destroyed or damaged. As a result, the flexor tendon may be injured. Inflammatory processes in the flexor tendons also promote the disease, with insufficiency of the flexor tendons also occurring in some cases.
If the swan neck deformity occurs on the fingers, it is usually a disorder of a special tendon plate. The middle joint is often affected. In addition, swan neck deformity is more common in patients suffering from chronic polyarthritis. In the context of accidents, the tendon plate may tear, causing the malposition to develop.
On the toe, mechanical stresses in the corresponding area are primarily responsible for the development of the swan neck deformity. The risk of this increases if the second toe is larger than the first.
Symptoms, Ailments & Signs
The swan neck deformity manifests itself in the typical misalignment that forms on the affected fingers and toes. In numerous cases, the disease shows up on the long fingers or on the second toe. If the fingers are affected by the swan neck deformity, the affected person sometimes finds it difficult to close their fist as usual. Thumb and forefinger grip is also impaired.
Diagnosis & course of disease
The diagnosis of the swan neck deformity is primarily based on the individual clinical symptoms. The malposition of the fingers or toes is usually relatively noticeable and prompts many sufferers to consult a doctor. The doctor treating you first takes what is known as anamnesis and clarifies the respective symptoms with the person suffering from the swan neck deformity.
Above all, he asks about the circumstances that may have led to the development of the disease. After the anamnesis, various examinations of the patient and their symptoms are carried out in order to reliably diagnose the swan neck deformity. Visual diagnostics plays an important role. The doctor checks, for example, whether the joints of the fingers are swollen. The function of the joints and tendons is also tested.
The doctor examines whether the incorrect position of the fingers or toes can be corrected either actively or passively. An important procedure is also the X-ray examination of the affected finger or the respective toe. In this way, important indications of the present disease can be recognized visually.
A swan neck deformity usually does not cause any major complications. However, the malposition affects the grip of the thumb and forefinger, which means that everyday tasks can no longer be carried out as usual. In severe cases, the deformity affects the professional performance of those affected and, as a result, can also cause psychological problems.
Furthermore, the misalignment represents a noticeable cosmetic blemish – mental suffering can also occur here. Treating swan neck deformity also comes with some risks. If the tendon is corrected as part of a tendon suture, bleeding, infections and other typical complications of an operation can occur. A tendonoplasty carries the risk of rejection reactions and infections. The fact that dead, frozen tendon tissue is used for a reconstruction is repulsive for some patients.
Occasionally, those affected still feel the tendon as foreign years later and develop psychological problems as a result. Further complications can occur after taking the prescribed painkillers and anti-inflammatories. Typically, there are gastrointestinal complaints, skin irritations or temporary headaches, muscle and body aches. Kidney and liver damage can occur in the long term.
When should you go to the doctor?
A doctor must always be consulted in the event of a swan neck deformity. Self-healing is not possible with this disease, so that the complaint makes everyday life of those affected significantly more difficult and significantly reduces their quality of life. In order to avoid further complications and symptoms, a doctor should always be consulted in the event of a swan neck deformity. A doctor should be consulted if various malpositions occur on the toes or fingers.
These misalignments do not always have to affect both limbs and can be different on the right and left side. Swelling of the joints and fingers can also indicate a swan neck deformity and should be examined by a doctor. In the first place, a general practitioner or an orthopedist can be consulted for this disease. Further treatment is then usually carried out by a specialist. The disease can usually be treated well.
Treatment & Therapy
Which treatment measures are used for swan neck deformity depends primarily on the respective causes of the disease. If the tendons have been injured by trauma, a so-called tendon suture is usually necessary. This will correct the damage to the tendons. However, if the causative injuries occurred a long time beforehand, a tendon plastic surgery is used, for example.
If rheumatoid factors lead to the development of the swan neck deformity, the severity of the deformity plays an important role. Possible methods of therapy are, for example, flexion splints. In the case of severe malpositions, a reconstruction of the tendon is necessary in some cases. Sometimes arthrodeses or synovectomies are used.
In the case of a swan neck deformity on the finger, the flexor tendons in the area of the middle joint are primarily reconstructed. Possible methods include tenodesis or arthrolysis. In some cases, the joint is also passively mobilized. Following a reconstruction, it is imperative to rest the affected area for a longer period of time.
As a rule, this is a period of about four weeks in which the middle joint is fixed in a flexed position. During this time, the joint cannot be stretched.
A swan neck deformity can be prevented by avoiding injuries or accidents.
After reconstruction, follow-up treatment usually involves partial immobilization at 20 to 30 degrees Celsius. The immobilization period is about one to four weeks and depends on the extent of the injured capsule and burn structures as well as the stability of the joint after reduction. While the middle joint is in a flexed position, it is allowed to flex, but extension is prevented.
A finger splint made of thermoplastic is used here, which is in the maximum possible stretched position. Care is taken to ensure that the immobilization is as short as possible, because the longer the joint is not moved, the more its mobility suffers. Occupational therapy can also be very helpful.
The more stable the affected joint is, the sooner manual therapy techniques can be used. These include, for example, traction, transverse gliding and support for the rolling and gliding movement of the joint. Before these techniques are applied, it is essential that the therapist gets an impression of the joint stability with the help of a rotational and translational function test, as well as the condition of the capsule and the subjective feeling at the end.
In addition, the patient should be asked to actively cooperate. This self-responsibility is stimulated by home tasks that the patient can carry out independently, for example with functional exercise equipment such as vibration equipment, dumbbells and brushes or utensils such as pin cushions.
You can do that yourself
In the area of self-help, precautionary measures should be taken during sporting activities or physical activities. Wearing protective clothing around the hands is advisable to minimize the risk of serious accidents or injuries. In addition, in these cases the body is less exposed to possible strong temperature fluctuations. Wearing gloves is necessary, especially when working in a cold environment.
Situations of overexertion or excessive strain on the hands and fingers should be avoided. At the first signs of physical impairment, rest periods and breaks must be taken. Sufficient rest is necessary so that the organism can regenerate itself. If there are injuries, the hands and fingers should not be strained if possible. Everyday life and the fulfillment of tasks to be performed should be restructured in order to avoid situations in which the hands are exposed to stress. If possible, sporting activities should be avoided or reduced to a minimum during the healing phase.
In order to avoid complications and conditions of high psychological tension, mental techniques for reducing stress should be used . Cognitive training helps in coping with everyday life and also in dealing with the swan neck deformity. The measures to strengthen mental strength are also helpful in dealing with complaints such as pain.