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Swan Neck Deformity: Treatment Based on Classification

(1) full passive movement of the PIP Joint;
    - functional loss in these pts is related to loss of DIP joint extension;
    - consider flexor synovectomy, intrinsic release, FDS tenodesis, dermadesis, retinacular ligament reconstruction or DIP arthrodesis (to correct primary mallet finger deformity);

(2) restriction of PIP flexion depending on MCP position (tight intrinsics)
    - flexion of the PIP Joint is restricted if the MCP joint is extended due to intrinsic muscle tightness;
           - flexion of MCP joint facilitates flexion of PIP Joint;
           - PIP flexion is limited due to MCP deformity w/ 2ndary intrinsic tightness;
           - as expected, the ulnar intrinsics are usually tighter than the radial intrinsics, therefore, placing the finger in radial deviation;
    - consider performing an intrinsic release & MP joint reconstruction if needed;

(3) restriction of PIP mostion w/ preserved joint space;
    - lateral band mobilization w/ or w/o pin fixation & or skin release;
    - hemitenodesis of FDS tendon to base of the middle phalanx is performed to limit hyperextension deformity of PIP Joint;
    - MCP arthroplasty is helpful in many instances;

(4) end stage deformity;
    - there is significant loss of articular cartilage w/ a complete loss of active and passive PIP Joint movement;
    - PIP fusion:
             - consider for index & or middle fingers if stability is important or if MP joint requires arthroplasty;
             - manditory if flexor tendon has ruptured;
    - PIP arthroplasty:
             - for 4th & 5th digits if adjacent tendons are intact;
             - early treatment involves splinting