In swan-neck deformity due to rheumatoid arthritis, which non-surgical option is commonly trialed before considering surgery?

• A. Joint mobilization
• B. Strengthening
• C. Stretching
• D. Splinting

Answer: (D)

Splinting is commonly trialed before surgery because it directly addresses the mechanical imbalance causing swan-neck deformity in rheumatoid arthritis. The deformity arises when the extensor mechanism at the PIP joint becomes unbalanced, allowing the PIP to hyperextend while the DIP flexes. An extension-block or swan-neck splint prevents PIP hyperextension, supports the volar plate, and redirects forces so the joints can achieve better alignment during use. This noninvasive approach can reduce pain, preserve finger function, and often delays or avoids the need for surgical correction, especially when combined with disease-modifying therapy and hand therapy. Other methods like joint mobilization, strengthening, or stretching don’t specifically correct the extensor balance and may not address the underlying deforming forces.