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Boutonniere Deformity

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Boutonniere deformity is a condition in which a tendon injury to the middle joint of the finger results in the inability to straighten the affected finger. Tendons in your fingers connect the finger bones to finger muscles and help bend and straighten the finger at the joint when the muscles contract.

The result is that the middle joint of the injured finger will not straighten, while the fingertip bends back.

Unless Boutonniere deformity is treated promptly, the deformity may progress, resulting in permanent deformity and impaired functioning

Boutonniere deformity, hand surgeons, Hand surgery, Splints

Signs and Symptoms of Boutonniere deformity

Boutonniere deformity is generally caused by a forceful blow to the top (dorsal) side of a bent (flexed) middle joint of a finger.

It also can be caused by a cut on the top of the finger, which can sever the central slip (tendon) from its attachment to the bone. The tear looks like a buttonhole (“boutonnière” in French).

In some cases, the bone actually can pop through the opening.

Boutonniere deformities may also be caused by arthritis.

Symptoms of Boutonniere Deformity

Signs of boutonniere deformity can develop immediately following an injury to the finger or may develop a week to 3 weeks later.The finger at the middle joint cannot be straightened and the fingertip cannot be bent.

Swelling and pain occur and continue on the top of the middle joint of the finger.

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.

In severe cases, a fragment of the bone may be displaced from its original position.

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Diagnosis of Boutonniere Deformity

If you believe that you have a Boutonniere deformity, or if you’ve recently injured your finger, you should schedule an appointment with a highly skilled hand surgeon to get a proper diagnosis.

A careful physical exam using certain special maneuvers will identify the deformity. Understanding how the injury has occurred, whether due to a recent traumatic event or a long-standing inflammatory disorder, is also essential to creating a treatment plan.

As a part of the exam, patients will get an x-ray to better help the doctor evaluate the condition of the joints in the finger, since joint fracture, subluxation, inflammation and degeneration can be the underlying culprit causing the deformity.

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Treatment of Boutonniere deformity

Boutonniere deformity

Boutonniere deformities can often be successfully treated with non-surgical methods which include:

  • Application of a splint to the middle joint of the affected finger to straighten it and allow the tendon to heal
  • Protecting your finger by taping it or using protective splints

  • Exercises to improve the flexibility and strength of your fingers

  • Use of oral medications or corticosteroid injections

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Surgical Treatment of Boutonniere deformity

While nonsurgical treatment of boutonniere deformity is preferred, surgery is an option in certain cases, such as when:

  • Boutonniere deformity results from rheumatoid arthritis.
  • The tendon is severed.
  • A large bone fragment is displaced from its normal position.
  • The condition does not improve with splinting.

Surgery can reduce pain and improve functioning, but it may not be able to fully correct the condition and make the finger look normal.

If the boutonniere deformity remains untreated for more than 3 weeks, it becomes much more difficult to treat.

Boutonniere deformity

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