SPECIAL ARTICLE

Swan neck deformity

William E Ridley,1 Hao Xiang,2 Jason Han2 and Lloyd J Ridley2,3
1
University of New England, Armidale, New South Wales, Australia
2
Department of Radiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia
3
Discipline of Medical Imaging, University of Sydney, Sydney, New South Wales, Australia

doi:10.1111/1754-9485.31_12786

The swan neck sign describes a characteristic appear-
ance in rheumatoid arthritis with fixed flexion of the dis-
tal interphalangeal joint and hyperextension of the
proximal interphalangeal joint (PIP).1 This is likened to
the appearance of a swan’s neck. The finding was origi-
nally a clinical description but has been adopted for use
in radiology.
Hyperextension of the PIP causes laxity of the exten-
sor tendons, thus preventing extension of the distal
interphalangeal joint (DIP). The greater the hyperexten-
sion of the PIP, the greater the flexion at the DIP. Hyper-
extension of the PIP is classified as either extrinsic
(increased tension in the extensor tendons, such as
hyperflexion of the wrist); intrinsic (intrinsic muscle
hyperactivity such as spasticity, muscle ischaemia or
trauma) or articular (joint laxity such as arthritis or
trauma). Aetiology is usually mixed.2
From a clinical perspective, a wide range of diseases
will cause a swan neck deformity. These include arthritis
(classically rheumatoid, but many others also can cause
it), neurological conditions (such as cerebral palsy and
stroke), connective tissue disorders with hypermobility
(such as Ehlers-Danlos) and trauma.2
Did you know?
The original description of the swan neck deformity is
credited to Archibald Garrod in 1890.2 The term ‘swan
neck’ was first used in the literature by Laine et al. in
1957,1 although it appears to have been in oral use before
this time.2 In 1859, Archibald’s father Sir Alfred Baring
Garrod was the first person to adopt the term Rheumatoid
Arthritis. Paintings demonstrate the swan neck deformity
several centuries prior to the medical descriptions, includ-
ing in the works of the 15th century painter Jan van Eyck.
Peter Paul Rubens, another famous painter of the early
17th century, also depicted changes of rheumatoid arthri-
tis and is thought to also suffer from this disease.3

© 2018 The Royal Australian and New Zealand College of Radiologists 159
 2. Dreyfus JN, Schnitzer TJ. Pathogenesis and differential
Related sign diagnosis of the swan-neck deformity. Semin Arthritis
• Digit deformity Rheum 1983; 13: 200–11.
○ Claw Toe 3. Hinojosa-Azaola A, Alcocer-Varela J. Art and rheuma-
tology: the artist and the rheumatologist’s perspec-
References tive. Rheumatology 2014; 53: 1725–31.

1. Laine VAI, Sairanen E, Vainio KA. Finger deformities

caused by Rheumatoid Arthritis. J Bone Joint Surg Am
1957; 39: 527–33.

160 © 2018 The Royal Australian and New Zealand College of Radiologists