- 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;
