Question:
The image shows a hand deformity. What is the most likely diagnosis?
The image shows a hand deformity. What is the most likely diagnosis?
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To easily remember the difference:
Swan Neck = PIP goes UP (hyperextension), DIP goes DOWN (flexion).
Boutonniere (Buttonhole) = PIP goes DOWN (flexion, pushing through the tendon like a buttonhole), DIP goes UP.
Swan Neck = PIP goes UP (hyperextension), DIP goes DOWN (flexion).
Boutonniere (Buttonhole) = PIP goes DOWN (flexion, pushing through the tendon like a buttonhole), DIP goes UP.
Updated On: Sep 3, 2026
- Swan neck deformity
- Boutonniere deformity
- mallet finger
- z-thumb deformity
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The Correct Option is A
Solution and Explanation
Concept:
The question asks to identify a classic hand deformity typically seen in advanced Rheumatoid Arthritis (RA) based on a visual description/image.
A Swan neck deformity is characterized by hyperextension of the Proximal Interphalangeal (PIP) joint and flexion of the Distal Interphalangeal (DIP) joint.
Explanation:
• In Rheumatoid Arthritis, chronic synovial inflammation leads to the destruction of joint capsules, ligaments, and tendons, resulting in characteristic biomechanical imbalances in the hand.
• Swan Neck Deformity (Option A): Occurs due to the stretching or rupture of the volar plate at the PIP joint, allowing the PIP to hyperextend. Concurrently, there is an imbalance in the extensor mechanism causing flexion at the DIP joint. This results in the characteristic "swan neck" appearance.
• Boutonniere Deformity (Option B): This is the exact opposite of the Swan neck deformity. It consists of flexion at the PIP joint and hyperextension at the DIP joint. It is caused by the rupture of the central slip of the extensor tendon at its insertion onto the middle phalanx, causing the lateral bands to slip volarly.
• Mallet Finger (Option C): Involves isolated flexion of the DIP joint due to the rupture or avulsion of the terminal extensor tendon. It does not primarily involve PIP hyperextension.
• Z-Thumb Deformity (Option D): Involves hyperextension of the interphalangeal (IP) joint of the thumb and flexion of the metacarpophalangeal (MCP) joint, with subluxation of the first carpometacarpal (CMC) joint.
Final answer:
Based on the typical radiographic/clinical presentation described (PIP hyperextension and DIP flexion), this is a Swan neck deformity.
The question asks to identify a classic hand deformity typically seen in advanced Rheumatoid Arthritis (RA) based on a visual description/image.
A Swan neck deformity is characterized by hyperextension of the Proximal Interphalangeal (PIP) joint and flexion of the Distal Interphalangeal (DIP) joint.
Explanation:
• In Rheumatoid Arthritis, chronic synovial inflammation leads to the destruction of joint capsules, ligaments, and tendons, resulting in characteristic biomechanical imbalances in the hand.
• Swan Neck Deformity (Option A): Occurs due to the stretching or rupture of the volar plate at the PIP joint, allowing the PIP to hyperextend. Concurrently, there is an imbalance in the extensor mechanism causing flexion at the DIP joint. This results in the characteristic "swan neck" appearance.
• Boutonniere Deformity (Option B): This is the exact opposite of the Swan neck deformity. It consists of flexion at the PIP joint and hyperextension at the DIP joint. It is caused by the rupture of the central slip of the extensor tendon at its insertion onto the middle phalanx, causing the lateral bands to slip volarly.
• Mallet Finger (Option C): Involves isolated flexion of the DIP joint due to the rupture or avulsion of the terminal extensor tendon. It does not primarily involve PIP hyperextension.
• Z-Thumb Deformity (Option D): Involves hyperextension of the interphalangeal (IP) joint of the thumb and flexion of the metacarpophalangeal (MCP) joint, with subluxation of the first carpometacarpal (CMC) joint.
Final answer:
Based on the typical radiographic/clinical presentation described (PIP hyperextension and DIP flexion), this is a Swan neck deformity.
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