This article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. Find sources: "Boutonniere deformity" – news · newspapers · books · scholar · JSTOR ( October 2008) ( Learn how and when to remove this template message) Medical condition Boutonniere deformity Boutonniere deformity deformity in a person with rheumatoid arthritis Specialty Rheumatology Boutonniere deformity is a deformed position of the fingers or toes, in which the joint boutonniere deformity the knuckle (the proximal interphalangeal joint, or PIP) is permanently bent toward the palm while the farthest joint (the distal interphalangeal joint, or DIP) is bent back away ( PIP flexion with DIP hyperextension).
Causes include injury,  inflammatory conditions like rheumatoid arthritis, and genetic conditions like Ehlers-Danlos syndrome.  Contents • 1 Pathophysiology • 2 Diagnosis • 2.1 Stages • 3 Treatment • 4 See also • 5 References • 6 Further reading • 7 External links Pathophysiology [ edit ] This flexion deformity of the proximal interphalangeal joint is due to interruption of the central slip of the extensor tendon such that the lateral slips separate and the head of the proximal phalanx pops through the gap like a finger boutonniere deformity a button hole (thus the name, from French boutonnière "button hole").
The distal joint is subsequently drawn into hyperextension because the two peripheral slips of the extensor tendon are stretched by the head of the proximal phalanx (note that the two peripheral slips are inserted into the distal phalanx, while the proximal slip is inserted into the middle phalanx). This deformity makes it difficult or impossible to extend the proximal interphalangeal joint.
Diagnosis [ edit ] Stages [ edit ] • Mild extension lag, passively correctable • Moderate extension lag, passively correctable • Mild flexion contracture • Advanced flexion contracture Higher numbers indicate a more severe problem and greater likelihood of a poor final outcome.
Treatment [ edit ] Usually treated with a splint placing the proximal interphalangeal joint in extension for 4–6 weeks.
Occasionally surgery is needed when splinting is unsuccessful. See also [ edit ] • Swan neck deformity • Z-deformity References [ edit ] • ^ "Boutonniére Deformity". Your Orthopaedic Connection. American Academy of Orthopaedic Surgeons .
Retrieved 15 April 2018. • ^ "Boutonniere Deformity". Further reading [ edit ] • Coons, Matthew S.; Green, Steven M. (August 1995). "Boutonniere deformity". Hand Clinics. boutonniere deformity (3): 387–402. doi: 10.1016/S0749-0712(21)00060-3. PMID 7559817. • Souter, William A. (October 1974). "The Problem of Boutonniere Deformity". Clinical Orthopaedics and Related Research. 104 (104): 116–133. doi: 10.1097/00003086-197410000-00012.
PMID 4607222. • Nalebuff, Edward A.; Millender, Lewis H. (July 1975). "Surgical Treatment of the Boutonniere Deformity in Rheumatoid Arthritis". Orthopedic Clinics of North America. 6 (3): 753–763. doi: 10.1016/S0030-5898(20)30987-1. PMID 1099508. • Littler, J. William; Eaton, Richard G.
(October 1967). "Redistribution of Forces in the Correction of the Boutonnière Deformity". JBJS. 49 (7): 1267–1274. doi: 10.2106/00004623-196749070-00002. PMID 5622971. • To, Philip; Watson, Jeffry T. (January 2011). "Boutonniere Deformity". The Journal of Hand Surgery. 36 (1): 139–142. doi: boutonniere deformity. PMID 21193133. • Massengill, James B. (November 1992). "The boutonniere deformity". Hand Clinics.
8 (4): 787–801. doi: 10.1016/S0749-0712(21)00744-7. PMID 1460075. • Aiache, Adrien; Barsky, Arthur J.; Weiner, Daniel L. (August 1970). "Prevention of the boutonniere deformity". Plastic and Reconstructive Surgery. 46 (2): 164–167. doi: 10.1097/00006534-197008000-00010. PMID 5423482. S2CID 39268503. • Curtis, Raymond M.; Boutonniere deformity, Robert L.; Provost, John M. (March 1983).
"A staged technique for the repair of the traumatic boutonniere deformity". The Journal of Hand Surgery. 8 (2): 167–171. doi: 10.1016/s0363-5023(83)80009-4. PMID 6833725. • Urbaniak, James R.; Hayes, Michael G. (July 1981). "Chronic boutonniere deformity—An anatomic reconstruction". The Journal of Hand Surgery. 6 (4): 379–383. doi: 10.1016/s0363-5023(81)80048-2. PMID 7252114.
• Dolphin, James A. (January 1965). "Extensor Tenotomy for Chronic Boutonnière Deformity of the Finger: REPORT OF TWO CASES". JBJS. 47 (1): 161–164.
doi: 10.2106/00004623-196547010-00011. PMID 14256963. External links [ edit ] • Boutonniere Deformity at eMedicine Edit links • This page was last edited on 15 Boutonniere deformity 2022, at 15:16 (UTC).
It can also be due to boutonniere deformity or weakening of the same tendon due to an injury or from a disease like rheumatoid arthritis. This results in the bent position of the joint. This bent position causes the small tendons on the side of the finger to slide toward the palm side.
This worsens the bent position of the finger’s middle joint. There can then be more pull on the end joint of boutonniere deformity finger. This causes the small joint bend further back. 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 boutonniere deformity in stiffness.
This can become permanent if you do not seek treatment. There are many treatments for a Boutonniere deformity. Splinting can be used, particularly if it is started soon after the tendon boutonniere deformity 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. Your treatment plan will vary, depending on your situation. Visit a hand surgeon to determine the best option for you. © 2017 American Society for Surgery of the Hand This content is written, edited and updated by hand surgeon members of the American Society for Surgery of the Hand.
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• Overview • Symptoms and Causes • Diagnosis and Tests • Management and Treatment • Prevention • Outlook / Prognosis • Living With • Frequently Asked Questions Boutonnière Deformity • Overview • Symptoms and Causes • Diagnosis and Tests • Management and Treatment • Prevention • Outlook / Prognosis • Living With • Frequently Asked Questions • Back To Top Overview What is boutonnière deformity?
Boutonnière deformity is a condition that affects your ability to straighten the middle joint of a finger or — less commonly — a toe. Your joint is stuck in a bent position and won’t straighten.
At the same time, the joint toward the tip of your finger or toe (extremity) is flexed upward.
If you’ve injured a tendon in your hand called the central slip extensor, you might develop a boutonnière deformity. Tendons are tissues made up of bundled fibers that connect muscle to bone so you can move.
The central slip extensor goes to the middle joint of your finger or toe. In boutonnière deformity, an injury tears the tendon and a slit appears. If this situation isn’t corrected, the middle of your finger will remain bent and the tip of your finger will stick out. It’s called a boutonnière deformity because the slit in the tendon looks like a buttonhole with the bone showing. Boutonnière means buttonhole in French.
Who does boutonnière deformity affect? Boutonnière deformity can happen to anyone. You can even be born with it. However, it’s more likely to happen if you play sports where you can jam your finger or if you have arthritis. It also can be caused by a cut to the top of the second knuckle of your finger from the tip, the proximal interphalangeal (PIP) joint.
If your tendon is severed from your bone, you won’t be able to straighten your PIP joint. Symptoms and Causes What are the signs and symptoms of boutonnière deformity? 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. • You can’t straighten out your finger or toe. • The tip of your finger or toe is flexed up.
• Your joints are stiff, which gets worse over time. What causes boutonnière deformity? Boutonniere deformity deformity happens as a result of an injury or cut to the tendon. This can happen because of: • Arthritis. • Hand injury that causes a deep cut, finger dislocation or fracture. • A birth defect. Diagnosis and Tests How is boutonnière deformity diagnosed? Your healthcare provider will take a complete medical history and do a thorough examination of the affected joint.
Your provider will perform an Elson’s test to evaluate your hand injury and see if the central slip is still intact.
Your provider will ask you to curl your fingers around a table edge. Then your provider will press on your middle phalanx (the boutonniere deformity that's between your knuckle and the boutonniere deformity before the tip of your finger) of the affected finger.
Your provider will ask you to extend your finger. If they can feel your finger attempting to straighten out, they’ll know that the central slip isn't torn or cut. If you’re not able to extend the finger, they’ll know the central slip isn’t working. You might need an X-ray if your provider thinks you might have a broken bone. Management and Treatment How is boutonnière deformity treated? Whatever happens, early treatment boutonniere deformity important.
Your provider will likely begin with nonsurgical options, unless your torn central slip boutonniere deformity exposed. An open wound will probably require surgery. Nonsurgical treatment is a splint that keeps your PIP joint straight, but allows your other joints to move.
You’ll have to wear the splint continuously for four to six weeks. Your provider might also suggest exercises. If you have rheumatoid arthritis, some of your medications are designed to stop your disease from getting worse (disease-modifying anti-rheumatic drugs) and damaging tissue (biologic response modifiers). Other medications are to stop pain and inflammation (non-steroidal anti-inflammatory medications and glucocorticoids). If your joint doesn’t heal, you might need joint replacement surgery.
What complications boutonniere deformity related to boutonnière deformity? There are complications from boutonnière deformity that may happen with or without treatment.
These include: • Long-term swelling and stiffness. • Arthritis after the injury. • Impaired joint movement. • Greater chance of damaging the joint again. Living With When should I see my healthcare provider about boutonnière deformity? If you have any injury to a joint, especially if you have an injury that amounts to a blow coming down on a flexed finger, see your healthcare provider as soon as possible. This is true also if you are cut or burned. If you can’t move a joint, especially one that is injured or has been damaged by arthritis, see your provider — the sooner the better.
Frequently Asked Questions What is the difference between boutonnière deformity and swan neck deformity? Swan neck deformity and boutonnière deformity are similar in some ways.
They can both happen at birth, or as a result of injury or arthritis. However, different joints are involved in these conditions. In swan neck deformity, the PIP joint is hyperextended and the distal interphalangeal (DIP) joint is bent. In boutonnière deformity, the PIP joint can’t be straightened. What is the difference between boutonnière deformity and pseudo boutonnière deformity? Pseudo boutonnière deformity and boutonnière deformity may look similar, but they aren’t quite the same.
The PIP joint is affected in both conditions. However, with pseudo boutonnière deformity, the injury is to the volar plate, or the ligament underneath the joint. The DIP joint will move if you move it. A note from Cleveland Clinic See your healthcare provider if you injure a finger or toe joint, if you have swelling that won’t go down or if you find it difficult to move the joint normally. If you’ve torn your central slip and you develop boutonnière deformity, it’s important to start treatment as early as possible to avoid permanent damage.
This is also true if you have arthritis and you notice your joint isn’t responding normally. • American Academy of Orthopaedic Surgeons.
Boutonnière Deformity. (https://orthoinfo.aaos.org/en/diseases--conditions/boutonniere-deformity/) Accessed 7/16/2021. • Binstead JT, Tafti D, Hatcher JD.
Boutonnière Deformity. (https://www.ncbi.nlm.nih.gov/books/NBK470323/) [Updated 2021 Jan 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan. Accessed 11/22/2021. • Freiberg A. Management of proximal interphalangeal joint injuries. (https://pubmed.ncbi.nlm.nih.gov/16843790/) Can J Plast Surg. 2007;15(4):199-203.
Accessed 11/22/2021. • Boutonniere deformity JP, Go JH, Hwang CH, Shin WJ. Restoration of the central slip in congenital form of boutonnière deformity: case report. (https://pubmed.ncbi.nlm.nih.gov/25042044/) J Hand Surg Am. 2014 Oct;39(10):1978-81. Accessed 11/22/2021. • McKeon KE, Lee DH.
Posttraumatic Boutonnière and Swan Neck Deformities. (https://pubmed.ncbi.nlm.nih.gov/26320165/) J Am Acad Orthop Surg. 2015 Oct:23(10): 623-632. Accesed 11/22/2021. • Papadopoulos DV, Bednar MS, Davidson A, Schmidt CC. Hand Surgery. Boutonniere deformity McMahon PJ, Skinner HB eds. Current Diagnosis & Treatment in Orthopedics, Sixth Edition. McGraw Hill, 2021. Accessed 11/22/2021. Boutonnière deformity is the result of an injury to the tendons that straightens the middle joint of your finger.
The result is that the middle joint of the injured finger will not straighten, while the fingertip bends back. Unless this injury is treated promptly, the deformity may progress, resulting in permanent deformity and impaired functioning. There are several tendons in your fingers that work together to bend and straighten the finger. These tendons run along the side and top of the finger. The tendon on the top of the finger attaches to the middle bone of the finger (the central slip of tendon).
When this tendon is injured, the finger is not able to be fully straightened. Cause Boutonnière 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 boutonniere deformity 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.
Boutonnière deformities may also be caused by arthritis. Symptoms Signs of boutonnière deformity can develop immediately following an boutonniere deformity 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. Boutonnière deformity must be treated early to help you retain the full range of motion in the finger. Nonsurgical Options Nonsurgical treatment is usually preferred, and may include: • Splints: A splint will be applied to the finger at the middle joint to straighten it.
This keeps the ends of the tendon from separating as it heals. It also allows the end joint of the finger to bend. It is important to wear the splint continuously for the recommended length of time -- usually 6 weeks for a young patient and 3 weeks for an elderly patient. Following this period of immobilization, you may still have to wear the splint at night. A commercial splint used in treating boutonnière deformity. Splinting helps keep the ends of the boutonniere deformity from separting during healing.
• Exercises: Your physician may recommend stretching exercises to improve the strength and flexibility in the fingers. • Protection: If you participate in sports, you may have to wear protective splinting or taping for several weeks after the splint is removed.
People with boutonnière deformity caused by arthritis may be treated with oral medications or corticosteroid injections, as well as splinting. Surgical Options 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. • 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. AAOS does not boutonniere deformity any treatments, procedures, products, or physicians referenced herein.
This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS Find an Orthopaedist program on this boutonniere deformity /> Article: • Pathology • History and etymology • See also • Related articles • References Images: • Cases and figures Pathology Boutonnière deformities occur when the central slip of the extensor digitorum tendon is torn or stretched resulting in PIP joint flexion.
Increasing PIP joint flexion causes further extensor retinaculum damage resulting in "buttonholing" of the proximal phalanx between the boutonniere deformity bands of the extensor tendon. Secondary DIP joint extension then occurs 4. Etiology • inflammatory arthritis 4 • central slip of extensor digitorum tendinopathy or rupture 4 History and etymology "Boutonnière" is French for buttonhole.
With the loss of integrity of the central aspect of the extensor tendon at the PIP joint, the PIP joint flexes, passing between the lateral bands just as a button passes through the buttonhole of a shirt.
• 3. Clavero JA, Alomar X, Monill JM et-al. MR imaging of boutonniere deformity and tendon injuries of the fingers. Radiographics. 2002;22 (2): 237-56. Radiographics (full text) - Pubmed citation • 4. William Palmer, Laura Bancroft, Fiona Bonar, Jung-Ah Choi, Anne Cotten, James F.
Griffith, Philip Robinson, Christian W.A. Pfirrmann. Glossary of terms for musculoskeletal radiology. (2020) Skeletal Radiology. doi:10.1007/s00256-020-03465-1 - Pubmed • 5.
Shiraishi M, Fukuda T, Igarashi T, Tokashiki T, Kayama R, Ojiri H. Differentiating Rheumatoid and Psoriatic Arthritis of the Hand: Multimodality Imaging Characteristics. (2020) RadioGraphics. 40 (5): 1339-1354. doi:10.1148/rg.2020200029 - Pubmed • autoimmune • seronegative spondyloarthritides • ankylosing spondylitis • bamboo spine • dagger sign • hatchet sign • shiny corner sign • enteropathic arthritis • psoriatic arthritis • arthritis mutilans • ivory phalanx • pencil-in-cup deformity • reactive arthritis (Reiter syndrome) • undifferentiated spondyloarthritis • signs • Andersson lesion • Romanus lesion • vertebral body squaring • juvenile idiopathic arthritis • lyme arthritis • rheumatoid arthritis • musculoskeletal manifestations of rheumatoid arthritis • Boutonniere deformity • hitchhiker thumb deformity • Z deformity • rheumatoid nodule • pulmonary manifestations • rheumatoid pulmonary nodule • robust rheumatoid arthritis • systemic lupus erythematosus • Jaccoud arthropathy • degenerative • osteoarthritis ( mnemonic) • post-traumatic osteoarthritis • erosive osteoarthritis • gull-wing appearance • grading • Kellgren and Lawrence system • osteoarthritis of the hip - grading • osteoarthritis of the knee - grading • Ahlbäck classification • rapidly destructive osteoarthritis of the hip • osteoarthritis of the hand • Bouchard nodes • Heberden nodes • osteoarthritis of the knee • scaphotrapeziotrapezoidal (STT) arthritis • osteoarthritis of the vertebral column • osteoarthritis of boutonniere deformity TMJ • primary cystic arthrosis of the hip • secondary synovial osteochondromatosis • depositional • amyloid arthropathy • crystal arthropathy • calcium pyrophosphate dihydrate deposition disease (CPPD) • gout • hyperuricemia • acute gouty arthritis • intercritical gout • chronic tophaceous gout • gouty nephropathy • hydroxyapatite crystal deposition disease (HADD) • Milwaukee shoulder • haemophilic arthropathy • Arnold-Hilgartner boutonniere deformity • infectious • septic arthritis • tuberculous arthropathy • Phemister triad • shoulder tuberculous arthropathy • miscellaneous disorders • avascular necrosis • osteochondral defects • primary synovial osteochondromatosis • related articles • erosive arthritis (differential) • joint ankylosis (differential) • monoarticular arthropathy • polyarticular arthropathy • monoarthritis (differential)
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Cite article Contents • 1 Introduction • 2 Definition • 3 Clinically relevant anatomy • 4 Aetiology • 5 Mechanism • 6 Signs and Symptoms • 7 Treatment • 7.1 Management of Rheumatoid Arthritis-related Boutonniere Deformities • 7.2 Physiotherapy management • 7.3 Surgical management • 7.4 Occupational Therapy • 8 References Introduction [ edit - edit source ] Extensor injuries of the hand are common in young, otherwise healthy males.
 Various injury mechanisms include hyperflexion, direct blunt trauma and penetrating trauma. When left untreated, disruption of the extensor mechanism over zone III and detachment of the central slip leads to a Boutonniere deformity. This deformity is characterised by flexion of the proximal interphalangeal joint (PIP) and hyperextension of the distal interphalangeal joint (DIP) due to the volar subluxation of the lateral bands.  Definition [ edit - edit source ] A Boutonniere deformity is a deformity of the fingers in which the proximal interphalangeal joint (PIP) is flexed and the distal interphalangeal joint (DIP) is hyperextended.
 It is an extensor tendon injury over zone III. It is also referred to as a "buttonhole deformity."  The Extensor Digitorum Communis(EDC) tendon at each finger splits into three bands or slips namely the central tendon/slip, which inserts on the base of the middle phalanx, and two lateral bands/slips, which rejoin as the terminal tendon/slip to insert into the base of the distal phalanx.
In order to produce active interphalangeal extension, the EDC muscle requires the assistance of two intrinsic muscle groups, the interossei and the lumbricals, that also have attachments to the extensor hood and the lateral bands/slips. The EDC tendon and all its complicated active and passive interconnections at and distal to the metacarpophalangeal joint are known together as the extensor mechanism.
The foundation of the extensor mechanism is formed by the tendons of the EDC muscle (with extensor indicis and extensor digiti minimi) and the extensor hood, the central tendon/slip, and the lateral bands/slips boutonniere deformity merge into the terminal tendon/slip. The triangular ligament helps stabilize the bands on the dorsum boutonniere deformity the finger. The triangular ligament provides boutonniere deformity to the lateral bands preventing palmar subluxation during flexion of the proximal interphalangeal joint.
    Aetiology [ edit - edit source ] A Boutonniere Deformity (BD) may develop secondary to trauma to the extensor mechanism over zone III or zone IV (including a direct laceration to the extensor mechanism), secondary to rheumatoid arthritis (RA), and in the setting of burns.
Reports of congenital Boutonniere deformities are also documented. The pathogenesis of a BD varies according to its aetiology.  Patients who suffer a traumatic BD may have been subject to a direct injury to the central slip or a force that placed the central slip on stretch, leading to failure of the extensor mechanism.
Direct injuries can occur when lacerations disrupt the central slip. Central slip injuries may also occur in the setting of passively forced flexion of an actively extended PIP joint.
In another scenario, a volar PIP joint dislocation can avulse the dorsal lip of the middle phalanx base and create a central slip disruption.  In people with Rheumatoid Arthritis, Boutonniere deformities develop and progress as the soft tissues of the digit are compromised.
The extensor mechanism is stretched as a result of synovial proliferation within the proximal interphalangeal joint (PIP). As a result of this, the central slip is compromised and unable to achieve full extension, therefore leading to a subtle extensor lag. With the PIP joint in slight flexion, the lateral bands are subluxated volar and become fixed volar to the axis of rotation.
Furthermore, the oblique retinacular ligaments contract, resulting in hyperextension and restricted flexion at the DIP joint. In the early stages of Rheumatoid arthritis, the joints are still passively correctable, but as the disease progress and capsular tissues contract and fibrosis developing around the PIP joint, the deformity becomes fixed.
  Boutonniere deformities that develop secondary to burns may be due to direct trauma or injury of the central slip or due to infection.   Mechanism [ edit - edit source ] Extensor hood If the central slip of the digital expansion is ruptured, minimal deformity results as long as the transverse ﬁbers of the expansion remain intact.
If they are also torn, a deformity is produced at the PIP joint. In this case, all extensor force will be transmitted to the distal phalanx by intact lateral bands, producing hyperextension of the DIP joint.
The PIP joint buckles into ﬂexion and protrudes through the breach in the extensor hood. The two lateral bands will now run on the palmar aspect of the PIP joint and will exaggerate ﬂexion.
   Signs and Symptoms [ edit - edit source ] Signs of the classic boutonnière deformity can develop immediately following an injury to the finger or may occur 10 to 14 days after the initial injury.  • Loss of extension at PIP joint and hyperextension at the DIP joint  • The finger at the middle joint (PIP) cannot be straightened and the fingertip (DIP joint) cannot be bent • A weak grip and an inability to grasp and manipulate small objects with the tip of boutonniere deformity digit boutonniere deformity Swelling and pain occur and continue on the top of the middle joint of the finger  There are 2 special tests that help in identifying injury to the extensor mechanism: • Elson Test - Fixing PIP Joint at 90° and ask the patient to extend the DIP joint.
A lax DIP joint, despite the patient's effort to extend, is a negative or normal finding (if the central slip is intact, the loose lateral bands/slips when the PIP is flexed prevent DIP extension).
A positive finding is a rigid DIP joint because of increased unopposed pull through the lateral bands/slips.  • Boyes Test - Extend PIP and ask to flex DIP; positive is unable to flex DIP actively  Boyes test may become positive only in the late stages.
 Treatment [ edit - edit source ] Management of Rheumatoid Arthritis-related Boutonniere Deformities [ edit - edit source ] Treatment options include prolonged splinting or surgery for patients who present for evaluation with a chronic injury such as in patients with Rheumatoid arthritis.
Stage PIP Joint DIP Joint 1 - Mild, Passively correctable, Normal articular surface. Splinting Injection and/or synovectomy Extensor tenotomy 2 - Moderate, Passively correctable, Normal articular surface. Treat as stage 1 ± Extensor reconstruction Extensor tenotomy 2 - Moderate, Partially passively correctable, Normal articular surface.
Treat as stage 1 Convert to correctable Extensor reconstruction Extensor tenotomy 2 - Moderate to severely fixed, Normal articular surface. Treat as above If correctable → Extensor reconstruction If not correctable →Salvage →Rarely volar release Extensor tenotomy 3 - Joint destruction Arthrodesis or arthroplasty Extensor tenotomy  Physiotherapy management [ edit boutonniere deformity edit source ] Treatment for an acute injury is uninterrupted boutonniere deformity of the PIP in full extension for 6 weeks.
An extensor lag greater than 15° is an indication to splint the DIP joint in slight flexion for several weeks to allow healing.  Boutonniere deformity 6 weeks of immobilization, exercises are begun. The exercise involves two sequential maneuvers. The first is active assisted PIP joint extension. This will stretch the tight volar structures, will cause the lateral bands to ride dorsal to the PIP joint axis, and will put longitudinal tension on the lateral bands and oblique retinacular ligaments.
The second maneuver is maximal active forced ﬂexion of the DIP joint while the PIP joint is held at 0°or as close to that position as the PIP will allow. This will gradually stretch the lateral bands and oblique retinacular ligaments to their physiologic length. Continue splinting 2 to 4 weeks when boutonniere deformity exercising. When full PIP joint extension can be maintained throughout the day, then night splinting only is appropriate. Length of treatment and splinting maybe several weeks.
  Surgical management [ edit - edit source ] Boutonniere deformity nonsurgical treatment boutonniere deformity 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 boutonniere deformity bone fragment is displaced from its normal position. • The condition does not improve with splinting.
Surgery can reduce boutonniere deformity 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 boutonniere deformity much more difficult to treat.  Occupational Therapy [ edit - edit source ] An Oval-8 Finger Splint which is basically a three point splint It holds PIP in a straight line and allows DIP to move freely.
It is easily removable and washable. It is also available in a tube for more comfort and cushioning effect.
Splinting is usually required for 6 weeks in conservative treatment.  DIP flexion exercises, with the PIP held in extension promotes pull through of the lateral Bands dorsally from the volar subluxed position. • ↑ de Jong JP, Nguyen JT, Sonnema AJ, Nguyen EC, Amadio PC, Moran SL. The boutonniere deformity of acute traumatic tendon injuries in the hand and wrist: a 10-year population-based study.
Clinics in orthopedic surgery. 2014 Jun 1;6(2):196-202. • boutonniere deformity 2.0 2.1 2.2 Geoghegan L, Wormald JC, Adami RZ, Rodrigues JN. Central slip extensor tendon injuries: a systematic review of treatments.
Journal of Hand Surgery (European Volume). 2019 Oct;44(8):825-32.
• ↑ Coons MS, Green SM. Boutonniere deformity. Hand clinics. 1995 Aug;11(3):387-402. • ↑ Dr Thomas Boutonniere deformity. What is a Boutonnière Deformity? Available from: http://www.youtube.com/watch?v=5M4wL-n_c3E [last accessed 5/10/2020] • ↑ Levangie PK, Norkin CC. Joint Structure and function: a comprehensive analysis. 3rd. Philadelphia: FA. Davis Company. 2000. • ↑ Johnson C, Swanson M, Manolopoulos K. A case report: Treatment of a boutonniere deformity III extensor tendon injury using a single relative motion with dorsal hood orthosis and a modified short arc motion protocol.
Journal of Hand Therapy. 2019 May 10. • ↑ Newton AW, Tonge XN, Hawkes DH, Bhalaik V. Key aspects of anatomy, surgical approaches and clinical examination of the hand. Orthopaedics and Trauma. 2019 Feb 1;33(1):1-3. • ↑ Digital MEdIC at Stanford University. Anatomy of the Upper Limb: Extensor Expansion.
Available from https://www.youtube.com/watch?v=G0v_wX8Ms4Y (last accessed 21 November 2020) • ↑ Kim JP, Go JH, Hwang CH, Shin WJ.
Restoration of the central slip in congenital form of boutonniere deformity: case report.
J Hand Surg Am. 2014 Oct. 39 (10):1978-81. • ↑ Feldon P, Terrono AL, Nalebuff EA, Millender LH. Rheumatoid arthritis and other connective tissue diseases. Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH, eds. Green’s Operative Hand Surgery. 6th ed.
Philadelphia: Elsevier; 2011. 2: 2052-6 • ↑ Dwivedi S, Testa EJ, Modest JM, Ibrahim Z, Gil JA. Surgical Management of Rheumatoid Arthritis of the Hand. Rhode Island Medical Journal. 2020 May 1;103(4):32-6. • ↑ Muir IFK, Barclay TL. Burns and Their Treatment. London: Lloyd-Luke; 1962. 109 • ↑ Grishkevich VM. Surgical treatment of postburn boutonniere deformity. Plast Reconstr Surg. 1996 Jan. 97 (1):126-32.
• ↑ Tsuge K. Congenital aplasia or hypoplasia of the finger extensors. Hand. 1975 Feb. boutonniere deformity. • ↑ 15.0 15.1 Hertling D, Kessler RM. Management of common musculoskeletal disorders.4th ed. Philadelphia : Lippincott Williams & Wilkins;1983. • ↑ Grandizio LC, Klena JC.
Sagittal band, boutonniere, and pulley injuries in the athlete. Current reviews in musculoskeletal medicine. 2017 Mar 1;10(1):17-22. • ↑ Nabil Ebraheim. Boutonniere Deformity Available from: https://www.youtube.com/watch?v=ncGPMKpKTv8 [last accessed 5/10/2020] • ↑ 18.0 18.1 18.2 Yoon AP, Chung KC. Management of acute extensor tendon injuries. Clinics in plastic surgery. 2019 Jul 1;46(3):383-91.
• ↑ 19.0 boutonniere deformity OrthoInfo. Boutonniere deformity. Available from: https://orthoinfo.aaos.org/en/diseases--conditions/boutonniere-deformity/ (accessed 4 October 2020) • ↑ Boyes JH. Bunnell's Surgery of the Hand. 5th ed. Philadelphia: JB Lippincott; 1971. 393. • ↑ Dr Vinay Kumar Singh. Elson's Test for Central Slip Injury. Available from: https://www.youtube.com/watch?v=eQbU0mPWtsE[last accessed 5/10/2020] • ↑ CRTechnologies. Boyes Test (CR). Available from: https://www.youtube.com/watch?v=m71MIeqLzys [last accessed 5/10/2020] • ↑ 23.0 23.1 Williams K, Terrono AL.
Treatment of boutonniere finger deformity in rheumatoid arthritis. The Journal of hand surgery. 2011;36(8):1388-93. • ↑ OrthoMontana. Wrist & Hand Rehab Techniques Following Sports Injury. Available from: https://www.youtube.com/watch?v=XEcQZ6fISqQ&t=4s [last accessed 5/10/2020] • ↑ RMCrayne.
ROM Therapy Strategies for Fingers.
Available from: https://www.youtube.com/watch?v=fgunRLNQMs8&t=1s [last accessed 5/10/2020] • ↑ Moussallem CD, El-Labaky CY, El-Yahchouchi CA, Hoyek FA, Lahoud JC. Extensor Boutonniere deformity Injuries. Journal of Hand Surgery. 2011;36(2):368. • ↑ 3-Point Products. How to Treat Boutonniere Deformity with an Oval-8 Finger Splint.
Available from: https://www.youtube.com/watch?v=d_QrmReS--M&t=3s [last accessed 5/10/2020] • ↑ Orfit Industries. Capener orthosis - Orficast Instructional Movie 3. Available from: https://www.youtube.com/watch?v=j3sscSSHe1E [last accessed 5/10/2020] .ERROR: The request could not be satisfied 403 ERROR The request could not be satisfied. Request blocked. We can't connect to the server for this app or website at this time. There might be too much traffic or a configuration error. Try again later, or contact the app or website owner.
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If you have this condition, you might not boutonniere deformity able to straighten out your finger, even if you try.
This condition can happen because of rheumatoid arthritis (RA) or osteoarthritis. It can also happen if the tendons in your finger are hit or cut (for instance, if your hand gets stepped on or crushed in a door). When this happens, the boutonniere deformity can be called a â€œjammed fingerâ€.
Similar Problems Mallet finger is a similar finger deformity that can be caused when a ball or other object hits that tip of your finger or thumb. Sometimes, this blow can be strong enough to tear the tendon that straightens the finger, which can make it bend without you being able to straighten it. If you have a boutonniÃ¨re deformity, you should see a healthcare provider as soon as possible.
If itâ€™s not treated, the bend in your finger can get worse over time, and you might even have permanent problems using your fingers and hands. Since the boutonniÃ¨re deformity is caused by damage to the hand, you might also have other symptoms or injuries that also need a healthcare providerâ€™s care. The most common causes of this deformity are injuries and rheumatoid arthritis. • Injury. The deformity can be caused by injuries to your hand. For example, instance, your finger could get hit while your finger joint is bent, or you could have a cut in the top of your finger joint that goes through the tendon.
Sports injuries can also cause this problem. • Rheumatoid arthritis. Rheumatoid arthritis, or RA, is an autoimmune disease that causes damage to your joints and connective tissues in your body. RA can cause inflammation that can hurt the tendon and middle joints of your finger, causing the deformity. If your healthcare provider thinks you have boutonniÃ¨re deformity, they will ask you some questions and do a physical exam of your finger and hands. Questions your healthcare provider might ask include: • When did your symptoms start?
• Were you injured? • Can you bend your finger back to being straight? Your healthcare provider might also order imaging tests, like x-rays, to take pictures of your boutonniere deformity and look for any other problems like broken bones or slipped tendons.
These tests will help your symptoms are caused by boutonniere deformity or a similar injury. If your healthcare provider diagnoses you with boutonniÃ¨re deformity, they might suggest a few different treatment options: • Splint. The most common treatment for boutonniÃ¨re deformity is a finger splint.
This is a stiff sleeve that goes over the finger and is secured with tape or Velcro. The splint helps keeps your finger straight for up to 6 weeks, giving the tendon a chance to heal. You may also need to wear a protective splint while playing sports for several weeks more. • Surgery. Surgery is more serious, but might be needed if the splint doesnâ€™t help, if your deformity is caused by RA, or if the tendon in your finger is cut all the way through.
In these cases, your healthcare provider might recommend surgery, like joint replacement or tendon repair, to help you get some of the function of your joints back. Prevention Sometimes, this deformity is caused by conditions that you canâ€™t prevent, like rheumatoid arthritis. However, injury is also a common cause of this condition. Taking some commonsense safety steps can help reduce the chance that your finger will be hurt. These include: • Drive safely. Automobile accidents are one of the leading causes of injuries in America.
• Be careful when playing sports. Sports and exercise can cause injuries to many parts of your body, including your hands. Using the proper equipment, stretching, and playing sports safely can lower your chance of injury.
• Be aware of your surroundings. You should look for things that might cause you to trip and fall like ice or extension cords. Be safe when moving furniture or lifting anything heavy to avoid getting your fingers and hands caught under these objects. About Intermountain Healthcare Intermountain Healthcare is a Utah-based, boutonniere deformity system of 24 hospitals (includes 'virtual' hospital), a Medical Group with more than boutonniere deformity physicians and advanced practice clinicians at about 160 clinics, a health plans division called SelectHealth, and other health services.
Helping people live the healthiest lives possible, Intermountain is widely recognized as a leader in clinical quality improvement and efficient healthcare delivery.