Correction of rheumatoid swan-neck deformity by lateral band mobilization

Fifty-seven digits in 18 hands of 14 patients with rheumatoid disease were retrospectively evaluated after surgical correction of swan-neck deformity. Release of each hyperextension deformity was done via a previously described lateral band mobilization technique with temporary pin fixation of the proximal interphalangeal (PIP) joint and primary skin closure. Extension block splinting was used for 1 month after pin removal. Follow-up averaged 24 months. Twenty-two percent of the patients were enthusiastic about their results, 56% were satisfied, 22% were equivocal, and none were dissatisfied. Maximum active flexion at the PIP joint averaged 55 degrees, and maximum extension averaged--10 degrees. The average distance from fingertip to distal palmar crease was 32 mm. Average grip strength was 10 kg of force in men and 4 kg in women. Step-cut lengthening of the central slip was associated with the development of a boutonniere deformity and an unsatisfactory result in three digits. Even with narrowing of the PIP joint or articular erosions, which were found on 91% of roentgenograms, lateral band mobilization to correct swan-neck deformity can predictably improve the function and cosmesis of rheumatoid hands.