A physical therapist treats a patient with rheumatoid arthritis who develops a swan-neck deformity, with onset six months prior and increasing hand pain and restricted mobility over the last six weeks. Which intervention is most effective given the deformity progression?

• A. Joint mobilization
• B. Strengthening
• C. Surgical intervention
• D. Stretching

Answer: (C)

When rheumatoid arthritis produces a swan-neck deformity, the problem is a fixed imbalance of the finger’s extensor mechanism and joint structures that often cannot be fully corrected with soft-tissue techniques alone. The PIP joint tends to hyperextend because the volar plate and surrounding structures become attenuated or damaged, while the cascade of joint changes limits flexion at the PIP and increases DIP motion restrictions. As the deformity progresses and the patient reports more pain and greater loss of function, simply mobilizing, stretching, or strengthening the involved fingers is less likely to restore meaningful function. The deformity represents structural changes that are best addressed by surgical correction to restore joint alignment and balance the extensor mechanism, thereby improving pain, motion, and grasp.

In this scenario, surgical intervention offers the most effective path to functional improvement because it directly corrects the fixed deformity and reallocates tendon tension to restore use of the hand. Conservative approaches may help with symptoms, but they don’t reliably reverse a progressing, fixed swan-neck deformity.