Swan Neck Deformity
When a finger buckles into a swan-neck shape, grip and dexterity suffer. Assessment, splinting and treatment to improve how the hand works, whether the cause is rheumatoid or an old injury.
- Certified Hand Therapist (CHT)
- Consultant Hand Therapist
- Hand, wrist & upper limb specialist
What is Swan Neck Deformity?
Swan neck deformity is an abnormal posture of the finger characterised by hyperextension (bending back) at the middle joint (PIP joint) combined with flexion (bending down) at the end joint (DIP joint). This gives the finger a swan-neck appearance, hence the name.
The deformity can result from a range of underlying causes including rheumatoid arthritis, mallet finger left untreated, PIP jont volar plate laxity or previous injury. Regardless of the cause, the mechanical imbalance between the finger's extensor and flexor systems drives the abnormal posture. Early specialist assessment and intervention gives the best chance of maintaining finger function and preventing a fixed deformity.
What you might notice
- Hyperextension (bending backwards) at the middle joint of the finger
- Flexion (drooping) of the fingertip at the end joint
- Difficulty initiating finger flexion: the finger may 'click' or require effort to begin bending
- Reduced grip and pinch strength
- Pain and swelling at the PIP joint, particularly in rheumatoid arthritis
- In fixed deformity, inability to straighten or bend the finger through full range
Why it happens
- Rheumatoid arthritis: synovitis can stretch the soft tissues and disrupt tendon balance
- Untreated mallet finger
- Generalised joint hypermobility
- PIP joint volar plate injury or ligament overstretching
- Neurological conditions such as cerebral palsy or following stroke
- Previous trauma or surgery disrupting the extensor mechanism
How it's treated
After a thorough assessment, a personalised treatment plan is built around your needs and goals.
Ms Razo can fit discreet orthoses that can be worn during daily activities and are highly effective for flexible deformities.
Targeted activities and exercises address the muscle and tendon imbalances driving the deformity. Therapeutic interventions are prescribed to restore normal finger movement patterns.
Where swan neck deformity is driven by rheumatoid arthritis or other systemic conditions, Ms Razo works alongside the patient's Rheumatologist and medical team to coordinate Hand Therapy within the wider management plan.
For fixed deformities requiring surgical correction, such as PIP joint release or tendon reconstruction, Ms Razo provides specialist post-operative rehabilitation to optimise the surgical outcome and restore functional hand use.
Common questions
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Flexible swan neck deformities, where the finger malposition can be corrected, respond well to splinting and Hand Therapy. Fixed deformities, where the joint cannot be passively corrected, are more likely to require surgery.
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These are opposite deformities of the finger. Swan neck deformity involves hyperextension at the middle joint (PIP) and flexion at the end joint (DIP). Boutonnière deformity is the reverse: flexion at the PIP joint and hyperextension at the DIP joint. Both can result from rheumatoid arthritis or injury, but require different treatment approaches.
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Not always. Swan neck deformity is one of several hand deformities associated with rheumatoid arthritis, but its development depends on which joints and tendons are most affected by the disease. Early Hand Therapy and splinting can slow progression and maintain hand function in rheumatoid arthritis.
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For flexible deformities, patients often notice improved function quickly with splinting. Sustained improvement requires consistent splint wear, typically for several weeks to months, alongside a Hand Therapy programme. Ms Razo will monitor progress and adjust treatment, as required.
Related hand conditions
Clinically reviewed by Ms Michelle Razo CHT · May 2026