Successful nonsurgical treatment is based on restoring balance in the structures of the hand and fingers. The proximal interphalangeal or PIP joint must be supple (not stiff). This is the middle knuckle of each finger. Aligning the PIP joint and preventing hyperextension should help restore distal interphalangeal or DIP extension (straightening the tip of the finger).
You may benefit from a session or two with a hand therapist. This is either a physical or occupational therapist who will address the imbalances that have formed the swan neck deformity. Stretching, massage, and joint mobilization are used to try and restore finger alignment and function. Special forms of stretching may help reduce tightness in the intrinsic muscles of the hand and fingers. Strengthening exercises can help with alignment and function of the hand and fingers.
A special splint may be used to keep the PIP joint lined up, protect the joint from hyperextending, and still allow the PIP joint to bend. No one need know there is a problem with the newer styles shaped like jewelry. These rings are available in stainless steel, sterling silver, or gold. Your therapist will work with you to obtain and use your finger splint. Be sure and mention your need to keep the problem to yourself.
This conservative approach works best for mild cases of swan neck deformity in which the PIP joint is still supple (i.e., not stiff or “stuck” and unable to move). The goal of nonsurgical treatment is to get the finger joints, tendons, and muscles in balance. If nonsurgical treatment is going to be successful, you may see improvement in eight to 12 weeks.