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| Tendon & Ligament Injuries > Boutonniere Deformity What is Boutonniere Deformity? Boutonniere deformity is an extensor tendon injury affecting two joints of the finger, the PIP (proximal interphalangeal) joint at the middle of the finger, and the DIP (distal interphalangeal) joint that controls the fingertip. These joints allow the finger to bend and flex. In boutonniere deformity there is a tear in the central part of the tendon that extends the finger. The finger bends down at the middle (PIP) joint and is pulled back up at the end (DIP) joint. When the finger is hit or bent forcibly in just the wrong way, the central tendon on top of the finger tears away from its attachment to the top of the bone in the middle of the finger. The tear in the tendon looks like a buttonhole (the French word boutonniere) and the end of the finger bone actually begins to stick through the tear. The tendon can no longer straighten the middle joint, which remains bent. The joint at the end of the finger flips upward. Causes of Boutonniere Deformity? Boutonniere deformity is usually caused by an injury, although it can also develop as a result of inflammatory disorders such as rheumatoid arthritis. Some people are born with a mild boutonniere position in most or all of their fingers. Sometimes this condition is the result of a cut on the top surface of the finger. The extensor tendon is positioned there, right under the skin, passing over the middle knuckle. Symptoms of Boutonniere Deformity? If you have had an injury that affects your ability to flex and extend your finger, seek medical attention immediately so that a doctor can diagnose the condition and limit damage. If the injury is recent the finger joints will be painful and tender. If the middle joint is swollen it is wise to apply ice to limit the flow of blood to the damaged tissue. The finger will appear misshapen, and you will not be able to straighten it. Treatment of Boutonniere Deformity? There is a limited period of time with boutonniere deformity during which treatment of any kind can be effective. Over time, the sensitive tissues of the hand and fingers lose their elasticity, increasing the difficulty of returning them to normal. Many people fail to seek treatment for this condition early enough, thinking they have only a "jammed finger." With prompt treatment, the probability of returning the finger to normal is much improved. Once your doctor confirms the problem, using x-rays to rule out the complication of a bone fracture, he or she will fit you with a custom boutonniere splint to help bend the end (DIP) joint down and straighten the middle (PIP) joint. This splint will leave the end joint free to move, and you will be shown how to gently exercise this joint. Depending on the nature of your particular injury, you may wear either a static or a dynamic splint. A dynamic splint helps develop full extension of the finger, allowing it to straighten over time. A static splint, used once the finger can be fully extended, immobilizes the middle joint to promote healing of the tendon. The mainstay of treatment is therapy. You will be shown how to effectively exercise the hand while the middle joint of the finger is extended and protected by the splint. Treatment time will vary. Young patients typically wear splints for at least 6 weeks, elderly patients for perhaps only three. In most cases proper splinting can eliminate the need for surgery. If surgery is recommended, it is best undertaken after the splint has stretched out the finger to its full extension. The finger should be limber enough to straighten and bend. Surgery is less likely to be effective for a stiff or fixed (long-term) boutonniere deformity. The aim of surgery is to reconstruct the attachment of the tendons. With rehabilitation and consistent exercise of the finger and hand, boutonniere deformity can be improved to at least a tolerable level most of the time. Some adjustment of normal hand activities may be required, particularly during the period of rehabilitation. The information provided herein is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting a licensed physician. ©2000 DynoMed.com, LLC, Indianapolis, IN |