Boutonnière deformity

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.

Symptoms

Signs of boutonnière 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.

Causes

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 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.

Boutonnière deformities may also be caused by arthritis.

FAQ

What movements are restricted in boutonniere deformity?
In boutonniere deformity, the finger is unable to straighten itself at the middle joint of the finger. Depending upon which finger is involved, it can restrict writing, typing, gripping among other activities.

Does boutonniere deformity get worse with time or age?
If treated earlier, the deformity can be fully corrected. IF untreated for longer periods, it can be difficult to restore normal movement. Age of presentation has no found correlation with degree of deformity.

How is boutonniere deformity diagnosed?
Mainly boutonniere deformity is diagnosed by clinical assessment and by performing movement assessing signs by the doctor – extending middle joint of the finger against resistance. X-ray is only ordered when there is suspicion of broken bones.

What is the treatment for boutonniere deformity?
Non-surgical treatment involves the use of splint – immobilises and straightens the joint to allow healing of the tendon. Exercises may also be advised for the same. Surgery may be needed in some cases.

For what duration of time is the splint put for boutonniere deformity?
A splint is mostly put for about 4 to 6 weeks. It may be vary depending upon various factors.

Who should get surgery for boutonniere deformity?
Surgery is recommended in cases of rheumatoid arthritis is the cause, if there is a broken or displaced bone due to the injury, or if splinting fails.

Is non-surgical treatment better than surgical treatment for boutonniere deformity?
Yes, splinting is preferred because surgery may leave behind abnormalities in appearance or motion. Whereas splinting restores normal function without invasion and to a greater degree of normalcy.

Can normal movement be restored completely after treatment for boutonniere deformity?
If medical attention is sought shortly after injury (recommended is 3 weeks) the deformity maybe completely reversed with minimal residual abnormalities like appearance. Delay can cause loss of function to some or all degree.