(BD; Buttonhole Deformity; Central Slip Disruption; Central Slip Injury; Deformity of Finger, Boutonnière; Extensor Tendon Rupture; PIP Joint Sprain)
Definition
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 FingerCopyright © Nucleus Medical Media, Inc.
|
Causes
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:
- 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
Risk Factors
Risk Factors
Factors that may increase your risk of developing BD include:
- Having rheumatoid arthritis or Dupuytren’s contracture
- Participating in contact sports, especially those involving catching and throwing balls such as football and basketball
Symptoms
Symptoms
Symptoms may include:
- Pain and swelling on the top of the finger’s middle joint—the PIP joint
- Inability to straighten the finger at the middle joint
- Sign of injury (such as fracture or dislocation) to the PIP joint
- Sign of injury (such as fracture or dislocation) to the MCP joint if the thumb is involved
Diagnosis
Diagnosis
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.
Treatment
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
Prevention
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.
RESOURCES:
Ortho Info—American Academy of Orthopaedic Surgeons http://orthoinfo.aaos.org
CANADIAN RESOURCES:
Canadian Physiotherapy Association http://www.physiotherapy.ca
References:
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.
Last Updated: 8/10/2015