Can Rheumatoid Arthritis Cause Swan-Neck Deformity in Fingers? | myRAteam

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Can Rheumatoid Arthritis Cause Swan-Neck Deformity in Fingers?

Medically reviewed by Ariel D. Teitel, M.D., M.B.A.
Posted on September 28, 2022

If you are one of the 1.5 million American adults living with rheumatoid arthritis (RA), you’ve likely experienced symptoms that affect the joints in your hands and fingers. One such symptom is swan-neck deformity, which causes a person’s fingers to bend abnormally and reduces their range of motion and function. Although several different conditions and injuries can cause swan-neck deformity, RA is the most common.

Here, we describe what swan-neck deformity is, what causes it, and common treatments and techniques for living with this symptom.

What Is Swan-Neck Deformity?

Swan-neck deformity is one of two classic finger deformities experienced by people living with RA. The other finger deformity is boutonniere deformity, which gives fingers a crooked appearance.

Members of myRAteam, the online support group for people with RA, describe their experiences with finger deformities. “My fingers are turning sideways on both hands,” one said. Another described, “My fingers are all turned sideways. I have huge nodules on all my knuckles.” “My joints feel like glass,” another commented, “They get numb and weak. I have dropped several things because of it.”

Specifically, swan-neck deformity is a condition in which the outermost finger joint (called the distal interphalangeal joint) bends inward (flexion), while the middle joint (proximal interphalangeal joint) straightens out (hyperextension). It usually affects all of the fingers except for the thumb, as the thumb has one fewer joint than the other fingers. This condition can be debilitating because it prevents normal bending and functioning of the fingers, which can affect many activities of daily life.

People with rheumatoid arthritis sometimes develop swan-neck deformity in their hands. It causes the outermost finger joints to bend inward while the middle joints straighten out. (Science Photo Library)


One of the first signs of developing swan-neck deformity is difficulty bending the middle finger joints. You may hear or feel a snapping sensation when trying to bend your fingers, which is caused by resistance of the tendons in the fingers. Over time, moving the fingers becomes more difficult as the finger joints scar and stiffen into a shape similar to a swan’s neck.

Causes of Swan-Neck Deformity

The most common cause of swan-neck deformity is RA, followed by other conditions such as:

  • Other forms of arthritis
  • Untreated mallet finger — A condition in which the fingertip curls down, typically from a tendon injury
  • Loose ligaments in the hand
  • Chronic muscle spasms due to nerve damage
  • A ruptured tendon
  • Poor healing of a fractured finger

Although an injury to a tendon, ligament, or nerves may cause swan-neck deformity in just one finger, RA can cause many or all of the fingers to be affected over time. Swan-neck deformity progresses gradually in people with RA.

As the middle joint of the finger hyperextends, the other tendons slide toward the back of the finger. Over time, this overextension of the middle joint prevents tendons at the end joint from straightening. This causes the unnatural bending at the middle and end joint of the finger.

Treatment and Management of Swan-Neck Deformity

There are three main treatment options for swan-neck deformity: treating your RA with medications, using ring splints on your fingers, and getting hand and finger surgery.

RA Treatment

First of all, and most impactfully, your health care team will aim to treat the underlying cause of your swan-neck deformity — in this case, RA. This requires finding a treatment plan that works best for you.

The most common classes of RA drugs include:

  • Disease-modifying antirheumatic agents (DMARDs)
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Biologics
  • Janus kinase (JAK) inhibitors
  • Steroids

Taking your treatment as prescribed and letting your doctor know about any side effects is the best way to keep your hand and finger health, as well as your overall condition, under control.

Ring Splints

Second, for those who have mild swan-neck deformity, doctors may recommend a type of finger splint, called ring splints. These are noninvasive splints that look like a ring, and they can help to slowly correct the deformity while allowing you to move your fingers.

A small study on people with osteoarthritis found that using a ring splint reduced pain, increased mobility, and increased quality of life in the short and long term. Another study showed that, when choosing a finger splint, many people living with RA consider appearance and comfort as much as effectiveness. Fortunately, ring splints can be purchased online and come in many designs and materials. Make sure to speak to your doctor before deciding if ring splints are the right option for you.

Surgery

Less frequently, but for more severe cases, surgery may successfully correct swan-neck deformity. One myRAteam member reflected, “It seems like for a few of us, surgery is our only option to deal with pain and deformity.”

For swan-neck deformity, an orthopedic surgeon may be able to realign joints that have left their natural state. They may also be able to fuse joints into positions that will improve finger function. This joint-fusion surgery is called interphalangeal arthrodesis, and although it prevents further deformity and relieves pain, it limits post-recovery mobility.

One member described a positive treatment experience with this surgery: “Last December, I had my right thumb metacarpophalangeal joint fused due to a classic RA deformity, swan-neck. I am very pleased, but I did lose some distal joint flexion. I am able to write, but my fine-motor strength is still weak after physical therapy.”

Note that any surgery comes with risks, and untreated RA may continue to cause finger deformity after surgery.

Preventive Practices

If you have RA and are worried about developing finger and hand deformities, there are ways to help prevent joint damage. One myRAteam member shared, “I wish I’d been more in tune with my body when it all started.”

One approach is to wear RA gloves. These gloves are meant to provide warmth and compression as they drain excess fluid around the joints and provide RA pain relief. However, no scientific research studies have proven their functionality in relieving swan-neck deformity or any other symptoms.

There are also hand exercises you can do to prevent and manage finger deformities, strengthen grip and joints, and stretch surrounding muscles. You can do these hand exercises at home for a few minutes every day to maintain your hand strength.

To reduce pain, one member shared a tip: “I did a lot of my stretches in a sink of warm water.” A physical or occupational therapist can help determine what hand therapy exercises will be safe and effective for you.

Talk With Your Doctor

If you have RA and swan-neck deformity, you are not alone. With the help of your health care team and RA community, there are ways to prevent and manage finger deformities caused by RA.

One member shared, “Do what your doctor and therapists say! I have persevered and have done what they suggested, and I’m very thankful. I have full motion in both of my hands now, with the exception of the middle joint on my right hand.”

Your doctor can help you understand your finger deformity, what’s causing it, and find the best ways to manage it.

Talk With Others Who Understand

On myRAteam, the social network for people with rheumatoid arthritis and their loved ones, more than 196,000 members come together to ask questions, give advice, and share their stories with others who understand life with rheumatoid arthritis. Here, finding ways to manage the many symptoms of RA is a commonly discussed topic.

Have you ever experienced swan-neck deformity while living with rheumatoid arthritis? How have you dealt with hand and finger symptoms? Share your experience and advice in the comments below, or start a conversation by posting on your Activities page.

    Posted on September 28, 2022
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    Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here.
    Scarlett Bergam, M.P.H. is a medical student at George Washington University and a former Fulbright research scholar in Durban, South Africa. Learn more about her here.

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