Leprosy
mailing list – September 6th, 2005
Ccn: all.
Ref.: swan neck
deformity.
From: R Schwarz, Pokhara,
Nepal.
Dear Salvatore,
I have been out
of the loop for a bit, but need to respond to Dr Srinavasan's comments
from July 13. While his distinction between "pseudo swan
neck" and "true swan neck" has its helpfulness, this is
not generally accepted terminology.
Swan neck is a very well described deformity with
many causes, and is defined as PIP hyperextension with DIP flexion
without reference to the MCP (see for instance Green's Operative Hand
Surgery Chap. 13, 55 and 62). Severe intrinsic shortening in
leprosy (a rare cause of swan neck in the global perspective) will
also give MCP flexion, but in leprosy what is more commonly seen would
be a swan neck due to overcorrection of clawing. In this condition,
still essentially an intrinsic plus aetiology, the MCP is not
necessarily flexed. Even more common would be the FDS minus finger.
What is needed is simply to note the cause of the
swan neck when it is detected. Dr. Srinivasan very correctly points
out that the aetiology of the swan neck must be determined before
treatment can be considered.
Yours,
Richard
Schwarz
Dr Richard
Schwarz FRCS
Box 5 Pokhara, Nepal
