Clinical Examples: Swan Neck Deformity after Palmar Fasciectomy for Dupuytren's Contracture

The most common joint position issues after palmar fasciectomy for Dupuytren's Contracture are persistent/recurrent flexion contracture and persistent Boutonniere contracture. Occasionally, liberal palmar release of the proximal interphalangeal joint and aggressive extension splinting can lead to hyperextension of that joint, a difficult management problem because the treatment of swan neck generally aims to prevent full extension and the goal of fasciectomy is to restore full extension.

 
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Dupuytren's, left hand before surgery:
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Fasciectomy:
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Six months postop:
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Five years postop, with painless snapping swan neck deformity, clinically and radiographically:
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Range of motion five years postop: soft snapping, loss of full PIP flexion, rubbery DIP flexion contracture. Palmar prominence of the proximal phalanx head due to hyperextension may be confused with a Dupuytren's nodule:
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Swan Neck and Dupuytren's

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