How is a type III 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

PIP joint manipulation involves dorsal skin release distal to the PIP joint to allow the skin edges to spread and scar contraction to occur in 2-3 weeks. This leads to a linear scar.

In lateral band mobilization, the lateral bands are freed from the central slip mechanism and the joint is gently manipulated into full flexion without releasing the collateral ligaments or lengthening the central slip. However, De Bruin et al reported disappointing results in their evaluation of the long-term effect of lateral band translocation for swan-neck deformity in 62 fingers of patients with cerebral palsy. [15] Although correction was successful in 84% of the fingers at 1 year after surgery, after 5 years, the success rate had declined to 60%. The authors additionally noted that they found no relationship between concomitant surgical procedures and swan-neck recurrences and concluded that lateral band translocation should not be considered a long-lasting procedure in these patients. [15]

Flexor tenosynovectomy or tenolysis involves exposing and applying traction to the flexor tendons of the distal palm. [16] (See also the article Hand, Flexor Tendon Lacerations.)

Once passive motion has been restored, the deformity may be corrected with the previously mentioned procedures. Postoperative splinting and exercises are implemented by a hand therapist, under the supervision of the surgeon, to maintain the gains that were achieved surgically.


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