Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive finger deformity characterized by hyperextension of the proximal interphalangeal (PIP) joint and flexion of the distal interphalangeal (DIP) joint. Symptoms include pain, stiffness, and functional impairment in grasping or fine motor tasks. History is significant for [Rheumatoid Arthritis/trauma/ligamentous laxity]. Onset is [acute/insidious], with reported difficulty in initiating flexion of the PIP joint.
Clinical Examination Findings
Physical examination reveals classic swan neck deformity of the [digit number]. PIP joint exhibits fixed or reducible hyperextension with associated DIP joint flexion. Assessment of intrinsic muscle tightness (Bunnell-Littler test) is [positive/negative]. Joint stability, range of motion, and neurovascular status of the affected digit are documented. No signs of acute infection or skin breakdown noted.
Treatment Protocol
Treatment plan includes: 1. Conservative management with custom-fitted silver ring splints or thermoplastic splints to prevent PIP hyperextension. 2. Occupational therapy for range of motion exercises and functional adaptation. 3. Pharmacological management of underlying inflammatory condition (e.g., DMARDs). 4. Surgical consultation for potential soft tissue reconstruction or arthrodesis if deformity is fixed or refractory to conservative measures.