II. Mechanism

  1. Volar plate injured in forced hyperextension of affected joint
    1. Usually affects PIP joint
    2. Partial or complete tear or avulsion Fracture
    3. Often occurs when the finger is dislocated dorsally
  2. Associated with PIP Collateral Ligament Injury
  3. Images
    1. FingerFlexorTendonInjury.png

III. Signs

  1. Tenderness at affected joint at volar aspect
  2. Evaluate collateral ligaments for stability
  3. Range of motion remains intact if stable joint

IV. Imaging: XRay

  1. Avulsion Fracture may be present

V. Management

  1. Referral indications
    1. Unstable joint
    2. Large avulsion Fracture
  2. Moderate, but stable injury (most cases)
    1. Progressive extension splint (block splint) of both PIP and DIP joints
    2. Aluminum splint initially angled 30 degrees flexion
    3. Progressively decrease flexion weekly by 5-10 degrees
      1. Week 1-2: 30 degrees
      2. Week 2-3: 20 degrees
      3. Week 3-4: 10 degrees
      4. Week 4: Full extension
    4. Buddy taping for an additional 2 weeks
  3. Mild injury
    1. Buddy taping to adjacent finger for 4 weeks
  4. Sport participation
    1. May participate if splinted or buddy taped

VI. Complications

  1. Hyperextension deformity (Swan-Neck deformity)

VII. References

  1. Leggit (2006) Am Fam Physician 73(5):810-23 [PubMed]
  2. Mercier (1995) Practical Orthopedics, p. 314

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Ontology: Swan-neck deformity (C0158477)

Concepts Acquired Abnormality (T020)
ICD9 736.22
ICD10 M20.03 , M20.039
SnomedCT 23060008
English Finger(s) Swan Neck Deformity, swan neck deformity of finger, acquired swan-neck deformity of finger, acquired swan-neck deformity of finger (diagnosis), swan neck deformity of finger (physical finding), Swan-neck deformity of unspecified finger(s), deformities swan neck, swan-neck deformity, Swan-neck deformity, Swan-neck deformity of finger, Swan-neck deformity (disorder)
Dutch zwanehalsmisvorming van vingers
French Déformation en col de cygne
German Schwanenhalsdeformitaet
Italian Deformazioni a collo di cigno
Portuguese Deformação em colo de cisne
Spanish Deformidad en cuello de cisne, deformidad en cuello de cisne (trastorno), deformidad en cuello de cisne
Japanese スワンネック変形, スワンネックヘンケイ
Czech Deformita tvaru labutí šíje
Hungarian Hattyúnyak deformitás

Ontology: Volar plate injury, finger, proximal interphalangeal joint (C0434451)

Concepts Injury or Poisoning (T037)
SnomedCT 209489004
English Volar plate injury finger PIPJ, Volar plate injury, finger, proximal interphalangeal joint, Volar plate injury, finger, proximal interphalangeal joint (disorder)
Spanish lesión de placa palmar, dedo de la mano, articulación interfalángica proximal (trastorno), lesión de placa palmar, dedo de la mano, articulación interfalángica proximal

Ontology: Volar plate injury of finger joint (C0435000)

Concepts Injury or Poisoning (T037)
SnomedCT 263125003
English Volar plate injury finger jt, Volar plate injury of finger joint, Volar plate injury of finger joint (disorder)
Spanish lesión de la placa palmar de articulación de dedo (trastorno), lesión de la placa palmar de articulación de dedo