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Best Physiotherapy for Swan- Neck Deformity In Delhi NCR.

Swan-Neck Deformity treatment and cure
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What is Swan- Neck Deformity ?

A Swan-Neck Deformity is a characteristic hand deformity characterized by a specific abnormal posture of the finger joints. It primarily affects the proximal interphalangeal (PIP) joint and the distal interphalangeal (DIP) joint of a finger (or multiple fingers).

Anatomy Involved:-

  • Metacarpophalangeal (MCP) joint: The knuckle joint where the finger meets the palm.
  • Proximal Interphalangeal (PIP) joint: The middle joint of the finger.
  • Distal Interphalangeal (DIP) joint: The joint closest to the fingertip.

Appearance of Swan-Neck Deformity:

In a Swan-Neck Deformity:-

  • The PIP joint is hyperextended (bent backward beyond its normal range).
  • The DIP joint is flexed (bent forward towards the palm).
  • The MCP joint may also be flexed, especially in rheumatoid arthritis.

This combined posture gives the finger a characteristic “swan-neck” appearance, resembling the graceful curve of a swan’s neck.

Causes of Swan-Neck Deformity:-

Swan-Neck Deformity is not a disease itself but rather a sign of an underlying problem that causes an imbalance in the forces acting on the finger joints, particularly the PIP and DIP joints. The primary culprits are usually issues with the extensor mechanism (the tendons that straighten the finger) or intrinsic muscles (small muscles within the hand).

The most common causes include:-

  • Rheumatoid Arthritis (RA): This is the most frequent cause. RA is an autoimmune disease that causes chronic inflammation of the joints. In RA, the inflammation can:
    • Stretch and weaken the volar plate (a ligament on the palm side of the PIP joint), leading to PIP hyperextension.
    • Cause inflammation and shortening of the intrinsic muscles, pulling the PIP joint into hyperextension.
    • Rupture or stretch the terminal extensor tendon at the DIP joint, leading to DIP flexion (a secondary “mallet finger” deformity).
  • Laxity of the Volar Plate: The volar plate is a strong ligament on the palm side of the PIP joint that prevents hyperextension. If it is congenitally loose, stretched, or torn (e.g., due to trauma, the PIP joint can hyperextend.
  • Mallet Finger Deformity: An untreated or severe mallet finger (rupture or avulsion of the terminal extensor tendon at the DIP joint, causing permanent DIP flexion) can, over time, lead to hyperextension of the PIP joint. The body tries to compensate, and the forces on the PIP joint become imbalanced.
  • Spasticity/Neurological Conditions: Conditions like cerebral palsy, stroke, or traumatic brain injury can cause muscle spasticity, where the muscles remain contracted. If the intrinsic muscles of the hand become spastic, they can pull the PIP joint into hyperextension.
  • Psoriatic Arthritis: Another inflammatory arthritis that can cause similar joint damage to RA.
  • Scleroderma/Systemic Sclerosis: Can cause tightening and scarring of soft tissues, affecting joint movement.
  • Trauma: Injuries that damage the extensor mechanism or volar plate can predispose to the deformity.
Symptoms of Swan-Neck Deformity:-
  • Difficulty with Finger Function: The most significant symptom. The altered joint mechanics make it difficult to:
    • Make a fist or grasp objects firmly.
    • Pick up small, flat objects (e.g., coins from a table), as the finger cannot achieve the necessary pulp-to-pulp pinch.
    • Perform fine motor tasks that require precise finger flexion (e.g., buttoning clothes, typing, writing).
  • Pain: May or may not be present, depending on the underlying cause (e.g., painful in active rheumatoid arthritis, less so in long-standing, stable deformities).
  • Stiffness: Reduced range of motion in the affected joints.
  • Weakness: Difficulty gripping or pinching.
Advanced Physiotherapy for Swan-Neck Deformity (including Manual Therapy)

Physiotherapy plays a vital role in managing Swan-Neck Deformity, especially in its early stages or when the deformity is still flexible. The goals are to restore joint alignment, improve function, reduce pain, and prevent progression. Treatment depends heavily on whether the deformity is flexible (can be corrected passively) or fixed (cannot be corrected).

Core Principles:-

  • Assessment: Thorough evaluation of joint mobility (active and passive), muscle strength, sensation, functional limitations, and underlying cause.

Manual Therapy-

    • Purpose: To improve joint mobility, reduce stiffness, and address soft tissue restrictions.
    • Techniques:
      • Gentle Joint Mobilizations: Targeting the PIP joint to discourage hyperextension and encourage flexion. This might involve gentle anterior-to-posterior glides at the PIP joint.
      • DIP Joint Mobilizations: To improve flexion, if restricted.
      • Soft Tissue Mobilization/Massage: Targeting the intrinsic muscles of the hand (e.g., lumbricals, interossei) to release tightness or shortening that contributes to PIP hyperextension. This can involve gentle kneading, sustained pressure, or cross-friction massage to reduce fibrosis.
      • Stretching: Gentle, sustained stretching of the tight intrinsic muscles and structures limiting PIP flexion. The therapist guides the patient in appropriate stretching techniques.
  • Therapeutic Exercises:
      • Intrinsic Muscle Stretching: Specific exercises to lengthen tight intrinsic muscles. This often involves flexing the MCP joints while extending the PIP and DIP joints.
      • PIP Flexion Exercises: Exercises to encourage and strengthen PIP flexion against resistance (e.g., gentle gripping exercises with soft putty or a sponge, finger ladder exercises).
      • DIP Flexion Exercises: If a mallet finger component is present, exercises to strengthen the DIP flexor (FDP tendon).
      • Functional Gripping Exercises: Incorporating exercises that mimic daily tasks, such as picking up small objects, buttoning, or using utensils, with proper joint alignment.
      • Strengthening of Extrinsic Flexors: To ensure a balance of forces.
      • Neuromuscular Re-education: Training the hand to move in a more functional pattern, focusing on activating the correct muscles for specific movements.
  • Modalities:
    • Heat: To relax muscles and improve tissue extensibility before exercises/stretching.
    • Ice: For pain and swelling after exercises or if there is an inflammatory component.

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