Boutonnière Deformity of Finger

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

Pronounced: boo-ten-EER de-FORM-uh-tee of finger

by Mary Cresse

Definition

Boutonnière deformity (BD) prevents straightening of the finger. The disorder affects the finger’s system of tendons. The tendons allow a person to flex and straighten his or her finger.

Tendons in Finger

Causes TOP

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. BD in the thumb 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 TOP

Factors that may increase the 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 TOP

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 TOP

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 TOP

Treatment options include the following:

Medication

The following medications may be advised:

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 the finger does not improve, surgery may be needed.

Surgery TOP

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 the finger to the way it was working before the injury. But, there may be some improvement. After surgery, exercises can help to strengthen the finger.

Prevention TOP

To help reduce your chance of getting BD:

Wear the proper equipment when playing sports.
If you have rheumatoid arthritis, ask you doctor about ways to protect your joints.

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:
...(Click grey area to select URL)
Published July 20, 2006. Accessed September 7, 2017.

Dupuytren disease. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114104/Dupuytren-disease . Updated February 9, 2017. Accessed September 7, 2017.

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

Last reviewed September 2018 by EBSCO Medical Review Board Teresa Briedwell, PT, DPT, OCS, CSCS
Last Updated: 8/10/2015

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