The patient is a 35-year-old female who got her finger caught in a metal staircase banister one day prior to presentation.

Physical examination is significant for R 5th finger PIP hyperextension and DIP hyperflexion (swan neck deformity). Her PIP flexion limited to about 20°, while her contralateral PIP joint shows about 100 degrees of flexion. No sensory or motor deficits noted.

View the x-rays taken (Figure 1 and 2) and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.

Clinical Challenge: January, 2009