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Boutonnière Deformity of Finger

(BD; Buttonhole Deformity; Central Slip Disruption; Central Slip Injury; Deformity of Finger, Boutonnière; Extensor Tendon Rupture; PIP Joint Sprain)

Definition

Boutonnière deformity (BD) prevents you from straightening your finger. The disorder affects the finger’s system of tendons. The tendons allow you to flex and straighten your finger.
Tendons in Finger
Finger Tendon
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Causes

In BD, the tendon on the top of the finger (called the central slip) is torn or cut from the other tendons. This creates a tear that resembles a buttonhole (or boutonnière in French). The first finger joint is forced down and the fingertip bends back at the second joint. 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:

Risk Factors

Factors that may increase your risk of developing BD include:

Symptoms

Symptoms may include:

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done, paying close attention to:
An x-ray may be done to see if you have a fracture.

Treatment

Talk with your doctor about the best treatment plan for you. Treatment options include the following:

Medication

Your doctor may recommend the following medications:
  • Corticosteroids—to reduce inflammation
  • Nonsteroidal anti-inflammatory drugs (NSAIDS)—to reduce pain and inflammation

Nonsurgical Approaches

For milder cases, the treatment is nonsurgical and may involve:
  • Splinting:
    • 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

Surgery is needed in severe cases. For example, 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.

Prevention

To help reduce your chance of getting BD, take the following steps:

RESOURCES

National Institutes of Arthritis and Musculoskeletal and Skin Diseases http://www.niams.nih.gov

Ortho Info—American Academy of Orthopaedic Surgeons http://orthoinfo.aaos.org

CANADIAN RESOURCES

Canadian Orthopaedic Foundation http://www.canorth.org

Canadian Physiotherapy Association http://www.physiotherapy.ca

References

Boutonniere deformity of the finger. Orthogate website. Available at: http://www.orthogate.org/patient-education/hand/boutonniere-deformity-of-the-finger.html. Updated July 27, 2006. Accessed August 10, 2015.

Dupuytren disease. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated July 15, 2014. Accessed August 10, 2015.

To P, Watson JT. Boutonniere deformity. J Hand Surg Am. 2011 Jan; 36(1):139-42.

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