Boutonniere deformity: Difference between revisions
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{{Infobox medical condition | |||
| name = Boutonniere deformity | |||
| image = [[File:RA_hand_deformity.JPG|left|thumb|A hand showing boutonniere deformity]] | |||
| caption = A hand showing boutonniere deformity | |||
| synonyms = Buttonhole deformity | |||
| specialty = [[Rheumatology]], [[Orthopedic surgery]] | |||
| symptoms = [[Flexion]] of the [[proximal interphalangeal joint]] and [[hyperextension]] of the [[distal interphalangeal joint]] | |||
| complications = [[Loss of function]], [[joint stiffness]] | |||
| onset = Often gradual | |||
| duration = Can be chronic | |||
| causes = [[Rheumatoid arthritis]], [[trauma]] | |||
| risks = [[Rheumatoid arthritis]], [[sports injuries]] | |||
| diagnosis = [[Physical examination]], [[X-ray]] | |||
| differential = [[Swan neck deformity]], [[Mallet finger]] | |||
| treatment = [[Splinting]], [[physical therapy]], [[surgery]] | |||
| prognosis = Varies, can be improved with treatment | |||
| frequency = Common in individuals with [[rheumatoid arthritis]] | |||
}} | |||
== Boutonniere Deformity == | == Boutonniere Deformity == | ||
[[File:RA_hand_deformity.JPG|left|thumb|A hand showing boutonniere deformity]] | |||
[[File:RA_hand_deformity.JPG|thumb | |||
'''Boutonniere deformity''' is a condition affecting the fingers, characterized by the flexion of the proximal interphalangeal joint (PIP) and hyperextension of the distal interphalangeal joint (DIP). This deformity is commonly associated with [[rheumatoid arthritis]], but it can also result from trauma or other connective tissue disorders. | '''Boutonniere deformity''' is a condition affecting the fingers, characterized by the flexion of the proximal interphalangeal joint (PIP) and hyperextension of the distal interphalangeal joint (DIP). This deformity is commonly associated with [[rheumatoid arthritis]], but it can also result from trauma or other connective tissue disorders. | ||
== Pathophysiology == | == Pathophysiology == | ||
Boutonniere deformity occurs due to the disruption of the central slip of the [[extensor tendon]] that inserts into the base of the middle phalanx. This disruption leads to the inability to extend the PIP joint, while the lateral bands of the extensor tendon slip below the axis of the joint, causing the DIP joint to hyperextend. | Boutonniere deformity occurs due to the disruption of the central slip of the [[extensor tendon]] that inserts into the base of the middle phalanx. This disruption leads to the inability to extend the PIP joint, while the lateral bands of the extensor tendon slip below the axis of the joint, causing the DIP joint to hyperextend. | ||
== Causes == | == Causes == | ||
The primary causes of boutonniere deformity include: | The primary causes of boutonniere deformity include: | ||
* '''Trauma''': Direct injury to the dorsal aspect of the finger can lead to rupture of the central slip. | * '''Trauma''': Direct injury to the dorsal aspect of the finger can lead to rupture of the central slip. | ||
* '''Rheumatoid arthritis''': Chronic inflammation can weaken the extensor mechanism, leading to deformity. | * '''Rheumatoid arthritis''': Chronic inflammation can weaken the extensor mechanism, leading to deformity. | ||
* '''Osteoarthritis''': Degenerative changes can also contribute to the development of boutonniere deformity. | * '''Osteoarthritis''': Degenerative changes can also contribute to the development of boutonniere deformity. | ||
== Diagnosis == | == Diagnosis == | ||
Diagnosis of boutonniere deformity is primarily clinical, based on the characteristic appearance of the finger. A physical examination will reveal: | Diagnosis of boutonniere deformity is primarily clinical, based on the characteristic appearance of the finger. A physical examination will reveal: | ||
* Flexion at the PIP joint | * Flexion at the PIP joint | ||
* Hyperextension at the DIP joint | * Hyperextension at the DIP joint | ||
[[File:RA_hand_deformity.JPG|left|thumb|Close-up of a hand with boutonniere deformity]] | |||
[[File:RA_hand_deformity.JPG|thumb | |||
In some cases, imaging studies such as [[X-ray]]s may be used to assess the extent of joint involvement and rule out fractures or other conditions. | In some cases, imaging studies such as [[X-ray]]s may be used to assess the extent of joint involvement and rule out fractures or other conditions. | ||
== Treatment == | == Treatment == | ||
Treatment of boutonniere deformity depends on the underlying cause and the severity of the condition. Options include: | Treatment of boutonniere deformity depends on the underlying cause and the severity of the condition. Options include: | ||
* '''Splinting''': Non-surgical management often involves splinting the PIP joint in extension to allow the central slip to heal. | * '''Splinting''': Non-surgical management often involves splinting the PIP joint in extension to allow the central slip to heal. | ||
* '''Physical therapy''': Exercises to improve range of motion and strengthen the surrounding muscles. | * '''Physical therapy''': Exercises to improve range of motion and strengthen the surrounding muscles. | ||
* '''Surgery''': In cases where conservative treatment fails, surgical intervention may be necessary to repair the extensor mechanism. | * '''Surgery''': In cases where conservative treatment fails, surgical intervention may be necessary to repair the extensor mechanism. | ||
== Prognosis == | == Prognosis == | ||
The prognosis for boutonniere deformity varies. Early intervention with splinting and therapy can lead to good outcomes, especially in cases caused by trauma. However, in chronic conditions like rheumatoid arthritis, the deformity may be more challenging to correct. | The prognosis for boutonniere deformity varies. Early intervention with splinting and therapy can lead to good outcomes, especially in cases caused by trauma. However, in chronic conditions like rheumatoid arthritis, the deformity may be more challenging to correct. | ||
== See also == | |||
== | |||
* [[Rheumatoid arthritis]] | * [[Rheumatoid arthritis]] | ||
* [[Extensor tendon injuries]] | * [[Extensor tendon injuries]] | ||
* [[Hand anatomy]] | * [[Hand anatomy]] | ||
[[Category:Musculoskeletal disorders]] | [[Category:Musculoskeletal disorders]] | ||
[[Category:Rheumatology]] | [[Category:Rheumatology]] | ||
Latest revision as of 19:35, 4 April 2025
Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
Founder, WikiMD Wellnesspedia &
W8MD medical weight loss NYC and sleep center NYC
| Boutonniere deformity | |
|---|---|
 | |
| Synonyms | Buttonhole deformity |
| Pronounce | N/A |
| Specialty | Rheumatology, Orthopedic surgery |
| Symptoms | Flexion of the proximal interphalangeal joint and hyperextension of the distal interphalangeal joint |
| Complications | Loss of function, joint stiffness |
| Onset | Often gradual |
| Duration | Can be chronic |
| Types | N/A |
| Causes | Rheumatoid arthritis, trauma |
| Risks | Rheumatoid arthritis, sports injuries |
| Diagnosis | Physical examination, X-ray |
| Differential diagnosis | Swan neck deformity, Mallet finger |
| Prevention | N/A |
| Treatment | Splinting, physical therapy, surgery |
| Medication | N/A |
| Prognosis | Varies, can be improved with treatment |
| Frequency | Common in individuals with rheumatoid arthritis |
| Deaths | N/A |
Boutonniere Deformity[edit]
Boutonniere deformity is a condition affecting the fingers, characterized by the flexion of the proximal interphalangeal joint (PIP) and hyperextension of the distal interphalangeal joint (DIP). This deformity is commonly associated with rheumatoid arthritis, but it can also result from trauma or other connective tissue disorders.
Pathophysiology[edit]
Boutonniere deformity occurs due to the disruption of the central slip of the extensor tendon that inserts into the base of the middle phalanx. This disruption leads to the inability to extend the PIP joint, while the lateral bands of the extensor tendon slip below the axis of the joint, causing the DIP joint to hyperextend.
Causes[edit]
The primary causes of boutonniere deformity include:
- Trauma: Direct injury to the dorsal aspect of the finger can lead to rupture of the central slip.
- Rheumatoid arthritis: Chronic inflammation can weaken the extensor mechanism, leading to deformity.
- Osteoarthritis: Degenerative changes can also contribute to the development of boutonniere deformity.
Diagnosis[edit]
Diagnosis of boutonniere deformity is primarily clinical, based on the characteristic appearance of the finger. A physical examination will reveal:
- Flexion at the PIP joint
- Hyperextension at the DIP joint
In some cases, imaging studies such as X-rays may be used to assess the extent of joint involvement and rule out fractures or other conditions.
Treatment[edit]
Treatment of boutonniere deformity depends on the underlying cause and the severity of the condition. Options include:
- Splinting: Non-surgical management often involves splinting the PIP joint in extension to allow the central slip to heal.
- Physical therapy: Exercises to improve range of motion and strengthen the surrounding muscles.
- Surgery: In cases where conservative treatment fails, surgical intervention may be necessary to repair the extensor mechanism.
Prognosis[edit]
The prognosis for boutonniere deformity varies. Early intervention with splinting and therapy can lead to good outcomes, especially in cases caused by trauma. However, in chronic conditions like rheumatoid arthritis, the deformity may be more challenging to correct.
