Boutonnière

Boutonniere with rose

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Boutonnière deformity is a condition affecting the fingers, specifically the alignment of the joints, which results in a characteristic bent position. This deformity occurs when the central slip of the extensor tendon that straightens the middle joint of the finger is damaged, leading to a flexion of the proximal interphalangeal (PIP) joint and an extension of the distal interphalangeal (DIP) joint. The term "boutonnière" is French for "buttonhole," which describes the appearance of the finger as it seems to poke through a buttonhole.

Causes

Boutonnière deformity can be caused by various factors, including:

• Rheumatoid arthritis: A chronic inflammatory disorder affecting joints, including those in the hands, which can lead to the deformity.
• Trauma: A direct injury to the finger, such as a cut or blunt force, can damage the extensor tendon.
• Burns or electrical injuries: These can cause scarring and shortening of the skin and tendons, leading to deformity.
• Congenital conditions: Some individuals are born with conditions that predispose them to develop this type of deformity.

Symptoms

The primary symptom of a Boutonnière deformity is the abnormal positioning of the finger, with the PIP joint bent towards the palm (flexed) and the DIP joint bent away from the palm (extended). Other symptoms may include:

• Pain and swelling in the affected finger
• Difficulty straightening the finger or extending the PIP joint
• Weakness in the affected finger

Diagnosis

Diagnosis of Boutonnière deformity typically involves a physical examination of the hand. A healthcare provider may also request imaging tests, such as X-rays, to assess the extent of the injury and to rule out other conditions.

Treatment

Treatment for Boutonnière deformity depends on the severity of the condition and the underlying cause. Options may include:

• Splinting: To keep the PIP joint in extension and allow the tendon to heal.
• Physical therapy: To strengthen the muscles and improve the range of motion.
• Surgery: In severe cases or when conservative treatments fail, surgery may be necessary to repair the damaged tendon or to correct the deformity.

Prevention

Preventing Boutonnière deformity involves avoiding injury to the fingers and seeking prompt treatment for any conditions that could lead to the deformity, such as rheumatoid arthritis.

See also

• Rheumatoid arthritis
• Extensor tendon
• Splinting
• Physical therapy

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