(BD; Buttonhole Deformity; Central Slip Disruption; Central Slip Injury; Deformity of Finger, Boutonnière; Extensor Tendon Rupture; PIP Joint Sprain)
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
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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:
- A powerful blow to the finger
- A cut to the finger’s central slip
- An injury to the first finger joint—called the proximal interphalangeal (PIP) joint
- A severe burn on the hand
Factors that may increase your risk of developing BD include:
Symptoms may include:
You will be asked about your symptoms and medical history. A physical exam will be done, 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. 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.
To help reduce your chance of getting BD, take the following steps:
- Wear the proper equipment when playing sports.
- If you have rheumatoid arthritis, ask you doctor about ways to protect your joints.
Ortho Info—American Academy of Orthopaedic Surgeons http://orthoinfo.aaos.org
Canadian Physiotherapy Association http://www.physiotherapy.ca
Updated July 27, 2006. Accessed August 10, 2015.
Dupuytren disease. EBSCO DynaMed website. Available at:
Updated July 15, 2014. Accessed August 10, 2015.
To P, Watson JT. Boutonniere deformity. J Hand Surg Am. 2011 Jan; 36(1):139-42.
Last Updated: 8/10/2015