Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive deformity of the right hand fingers, characterized by hyperextension of the proximal interphalangeal (PIP) joint and flexion of the distal interphalangeal (DIP) joint. Reports associated pain, stiffness, and functional impairment in grasping objects. Onset is insidious, consistent with underlying inflammatory arthropathy or chronic ligamentous laxity.
Clinical Examination Findings
Right hand examination reveals classic swan neck deformity involving [specify digits]. PIP joints demonstrate fixed or reducible hyperextension with compensatory DIP joint flexion. MCP joints show [stable/subluxed] alignment. Assessment of intrinsic muscle tightness (Bunnell-Littler test) is [positive/negative]. Neurovascular status is intact distally.
Treatment Protocol
Initial management includes custom-molded silver ring splints or thermoplastic orthoses to prevent PIP hyperextension and facilitate functional DIP flexion. Referral to hand therapy for strengthening of intrinsic muscles and joint protection techniques. Consider corticosteroid injections for inflammatory flares or surgical intervention (soft tissue reconstruction or arthrodesis) if deformity is fixed and refractory to conservative measures.