How is a type II swan-neck deformity in rheumatoid arthritis (RA) treated?

Updated: Jan 11, 2019
  • Author: Michael Neumeister, MD, FRCSC, FACS; Chief Editor: Joseph A Molnar, MD, PhD, FACS  more...
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Answer

Answer

The treatment of a type II deformity centers on the relief of intrinsic tightness, which is accomplished using intrinsic release. In this procedure, a dorsal longitudinal incision is made over the proximal phalanx, exposing the extensor mechanism. A rhomboid portion of the ulnar extensor aponeurosis is then resected (radial as well, if the tightness is severe). The surgeon resects the lateral band(s) through which the abnormally tight intrinsics have produced MP flexion and PIP hyperextension. In patients with severe involvement of the MP joints, silicone-implant arthroplasty is performed, combined with the rebalancing of the intrinsics and the long extensor tendons. [13, 14]


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