Treatment of Boutonniere and Swan-Neck Deformities in Rheumatoid Fingers

Abstract

Rheumatoid finger deformities can limit hand function significantly in patients with rheumatoid arthritis (RA). A swan-neck deformity is ultimately the result of hypertrophied rheumatoid synovium and consists of hyperextension at the proximal interphalangeal (PIP) joint with a flexion deformity at the distal interphalangeal (DIP) joint. Although the deformity usually begins at the PIP joint, it can also result from the destructive effect of synovitis at the metacarpophalangeal (MCP) joint or the DIP joint. In comparison, a boutonniere deformity is caused by synovitis at the PIP joint and is characterized by flexion of the PIP joint with hyperextension of the DIP joint. Surgical correction of these rheumatoid finger deformities depends on the severity of the deformity and aim to improve function and relieve pain in the affected hand. This chapter is intended to provide detailed explanations of current surgical techniques available to treat swan-neck and boutonniere deformities and the indications for each procedure.