A boutonniere deformity occurs as a result of the disruption, or tear, of the extensor tendon found at the top of the finger, known as the ‘center slip.’ This disruption keeps the middle joint of the finger (known as the PIP joint) from straightening, and causes the end joint of the finger, known as the DIP joint, to hyperextend and become difficult to bend.
A tear in the central slip can result from a cut to the tendon, an inflammatory disease like arthritis, or a dislocation of the PIP joint as the result of a direct blow to the tip of the finger (such as with a basketball). While it may seem like a simple ‘jammed finger’ that will heal on its own, a tendon injury left untreated can result in permanent stiffness to the injured joint. People with a boutonniere deformity will be unable to straighten their finger and will have difficulties with everyday activities, such as writing and buttoning their clothes.
Symptoms
After an injury, symptoms of boutonniere may include difficulty straightening the PIP (middle) joint of the finger on its own (without help from the other hand), along with swelling and discomfort. In cases of boutonniere that has gone untreated for a while, the finger may become stiff, without the ability to be straightened at all.
Treatment
If you’ve recently injured a finger and have symptoms of early boutonniere deformity, see a physician for diagnosis. He or she will likely refer you to a hand therapist for a custom splint, or orthosis. The hand therapist will place the finger in a proper position for correct healing and provide instructions for reducing swelling in the finger.
Boutonniere deformities that are a result of an untreated injury, arthritis, or laceration may require surgery. Board-certified hand specialists have received training specific to the treatment of hand problems and are experienced at treating this highly complex part of the body. After surgery, a hand therapist may provide a splint and specialized home exercise program to help the finger return to normal function.
The Muskegon Surgical Associates Hand Center treats a wide variety of hand conditions, including boutonniere deformity. Our team is highly trained and skilled, specializing in hand surgery and therapy. Contact us to make an appointment.
Sources: ASHT