Boutonnière Deformity of Finger
(BD; Buttonhole Deformity; Central Slip Disruption; Central Slip Injury; Deformity of Finger, Boutonnière; Extensor Tendon Rupture; PIP Joint Sprain)
Pronounced: boo-ten-EER de-FORM-uh-tee of finger
Boutonnière deformity (BD) affects the finger’s system of tendons. The tendons allow you to flex and straighten you finger. If you have BD, you cannot straighten your finger.
Tendons in Finger
In BD, the tendon on the top of the finger (called central slip) is torn or cut from the other tendons. This creates a tear that resembles a buttonhole (or boutonnière in French). The middle joint is forced down, and the fingertip bends back. The tendons on this part of the finger are flat and thin. They are prone to injury. If you have BD in the thumb, it affects a joint called the metacarpophalangeal (MCP).
BD can be caused by:
- Powerful blow to the bent finger
- Cut to the finger’s central slip
- Injury to the middle finger joint (called the proximal interphalangeal [PIP] joint)
- Severe burn on the hand
These factors increase your chance of developing BD:
- Having rheumatoid arthritis]]> or ]]>Dupuytren’s contracture]]>
- Participating in rough sports, especially those involving catching and throwing balls (eg, football, basketball)
Tell your doctor if you have any of these risk factors.
If you have any of these symptoms do not assume it is due to BD. These symptoms may be caused by other conditions. Tell your doctor if you have any of these:
Your doctor will ask about your symptoms and medical history. She will also perform a physical exam, paying close attention to:
- Muscle strength
- Joint damage
- Range of motion
- Presence of swelling
- Evidence of infection
- Tenderness in the finger
An x-ray]]> may be done to see if you have a fracture.
Talk with your doctor about the best treatment plan for you. Treatment options include the following:
Your doctor may recommend the following medications:
- Corticosteroids—to reduce inflammation
- Nonsteroidal anti-inflammatory drugs (NSAIDS)—to reduce pain and inflammation
For milder cases, the treatment is nonsurgical and may involve:
- Applied to the middle joint to fully extend it
- Used for 3-6 weeks
- Stretching and strengthening exercises
- Other techniques: massage]]> , ultrasound therapy, electrical stimulation
If your finger does not improve, you may need surgery.
Surgery is needed in severe cases. This may include when the tendon is cut or when the deformity has lasted a long time. Surgery generally does not return your finger to the way it was working before the injury. But, you may have some improvement. After surgery, you will have to do exercises to strengthen the finger.
American Academy of Orthopaedic Surgeons
National Institutes of Arthritis and Musculoskeletal and Skin Diseases
Canadian Orthopaedic Foundation
Physical Therapy Canada
Boutonniere deformity. Orthosports website. Available at: http://www.orthosports.com.au/hand_boutonniere.html . Accessed November 19, 2008.
Boutonniere deformity of the finger. Orthogate website. Available at: http://www.orthogate.org/patient-education/hand/boutonniere-deformity-of-the-finger.html . Updated July 2006. Accessed November 18, 2008.
Deformities. Merck website. Available at: http://www.merck.com/mmpe/sec04/ch042/ch042b.html . Updated March 2008. Accessed November 18, 2008.
Dupuytren’s contracture. EBSCO Publishing DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated September 2008. Accessed November 10, 2008.
Functional thumb orthosis for type I and II boutonniere deformity on the dominant hand in patients with rheumatoid arthritis: a randomized controlled study. EBSCO Publishing Consumer Health Complete website. Available at: http://www.ebscohost.com/thisMarket.php?marketID=14 . Updated August 2008. November 10, 2008.
Huber L. Boutonnière deformity of the finger. EBSCO Publishing Rehabilitation Reference Center website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=16topicID=860 . Updated August 2008. Accessed November 10, 2008.
Peterson EA. Sports-related wrist and hand injuries. EBSCO Publishing Patient Education Reference Center website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=16topicID=1034 . Updated May 2008. Accessed November 10, 2008.
PIP joint dislocation. EBSCO Publishing DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated July 2008. Accessed November 10, 2008.
Stedman’s Medical Dictionary. 28th ed. Baltimore, MD: Lippincott Williams & Wilkins; 2005;502;436.
Last reviewed December 2008 by ]]>John C. Keel, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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