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Boutonniere Deformity

Overview


Boutonniere deformity describes a medical condition in which the finger is flexed at the proximal interphalangeal joint (PIP) and hyperextended at the distal interphalangeal joint (DIP). This is usually a result of trauma in the acute setting and is caused by a rupture of the PIP central slip.


Signs and Symptoms

A cut of the tendon on the back of the middle joint will result in difficulty straightening that joint. The change in position of the end joint may not be seen initially but usually happens over time. The deformity may become worse over time if not treated. If the deformed position is not treated, it can result in stiffness. This can become permanent if you do not seek treatment.


Treatment

There are many treatments for a Boutonniere deformity. Splinting can be used, particularly if it is started soon after the tendon is injured. Splinting alone may not give a good result in a case where the deformity is caused by rheumatoid arthritis. Multiple different surgical options have been used to treat this problem. In the case of a cut tendon, the best results are generally seen when the tendon is repaired early. Even with surgery, a normal position of the joints is commonly not seen.



What is a boutonniere deformity?

A boutonniere deformity is a condition that affects the joints in one of your fingers. It causes the middle joint of your finger to bend in, and the outermost joint to bend out. It’s also called a central slip injury.

It’s often caused by rheumatoid arthritis. Other possible causes include:

1.finger dislocation

2.finger fractures

3.deep cuts

4.osteoarthritis

There are both surgical and nonsurgical treatment options for treating boutonniere deformities, depending on the severity.


Exercises

A boutonniere deformity can affect your finger’s range of motion and flexibility. Your doctor may recommend doing some exercises to help strengthen the affected finger, such as:

1.raising and lowering your finger at the knuckle

2.bending and straightening the tip of your finger


Medications

If your boutonniere deformity is due to rheumatoid arthritis or osteoarthritis, wearing a splint and doing strengthening exercises may not be enough. You doctor may instead prescribe medication, including corticosteroid injections to reduce inflammation and swelling. They might also instruct you to wear a splint while taking medication.


Nonsurgical treatment

Mild cases of boutonniere deformity usually don’t require surgery.


Surgical treatment

In some cases, boutonniere deformities require surgery. This is more likely in cases caused by advanced rheumatoid arthritis or severe injuries.

There are several different approaches for surgically treating a boutonniere deformity, including:

1.cutting and releasing tendons

2.cutting and sewing together damaged tendons

3.using a piece of tendon from another area

4.using wire or small screws to straighten the joints

It generally takes about 12 weeks to recovery from these types of surgery, and you may have limited use of your affected hand during that period.


Is boutonniere deformity painful?

The symptoms and signs of boutonnière deformity are visible. You have swelling and pain at the middle joint of the finger or toe. If your thumb is affected, it will be bent at the first joint.


Is boutonniere deformity permanent?

A boutonniere deformity results from an injury to your top tendon. The injury stops the middle joint of your affected finger from straightening out, so it stays permanently bent. If left untreated, the deformity gets worse with time. The result is permanent joint damage and impaired finger function.


Does boutonniere deformity need surgery?

While nonsurgical treatment of boutonnière deformity is preferred, surgery is an option in certain cases, such as when: The deformity results from rheumatoid arthritis. The tendon is severed. A large bone fragment is displaced from its normal position.
















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