Treating the Proximal Interphalangeal Joint in Swan Neck and Boutonniere Deformities.

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Abstract

[Indexed for MEDLINE] 7. Hand Clin. 2025 Feb;41(1):103-116. doi: 10.1016/j.hcl.2024.08.004. Epub 2024 Oct 18. Swan-Neck and Boutonniere Deformity in Rheumatoid Hand. Pfanner S(1), Poggetti A(2). Author information: (1)Hand Surgery and Reconstructive Microsurgery Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy; AOUC - Padiglione 25 CTO Largo Brambilla 3, Florence 50139, Italy. Electronic address: pfannners@aou-careggi.toscana.it. (2)Hand Surgery and Reconstructive Microsurgery Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy; AOUC - Padiglione 25 CTO Largo Brambilla 3, Florence 50139, Italy. Rheumatoid arthritis (RA) is an inflammatory disease for which the exact cause is unknown. It is an autoimmune disorder that primarily affects such joints which allows free movement in different directions, but also has many other severe complications related to mortality. On the other hand, this disease is responsible for digital deformities, arising out of a combination of synovitis, intrinsic muscles, and extrinsic tendons impairment, ligament rupture, joint dislocation, and final ankylosis. Articular swelling due to synovial proliferation is the first manifestation, but later deformity, subluxation, instability, contracture, and ankyloses can be visible with joint degeneration. Rupture of the capsular and tendon often happens at the wrist. Intrinsic and extrinsic muscle contractures are associated with typical hand joint malalignment. Osteoarthritic involvement has changed with the introduction of biologic disease-modifying anti-rheumatic drugs (bDMARD). Copyright © 2024 Elsevier Inc. All rights reserved. DOI: 10.1016/j.hcl.2024.08.004