Boutonniere Deformity is a common extensor tendon injury. The extensor tendons are located just under the skin on the back of the hands and extend to the fingertips. They allow the straightening of the fingers and thumb. Jamming a finger or even a minor cut to the top of the finger can injure these tendons. It is a common injury in basketball players. Boutonniere Deformity occurs when the middle joint of the finger (the central slip tendon) gets stuck in a bent-down position while the fingertip is flexed back.
While Boutonniere Deformity can result immediately following trauma, it more likely develops weeks later or as the result of rheumatoid arthritis. In fact, almost half of patients with rheumatoid arthritis will develop a Boutonniere Deformity.
Symptoms and Diagnosis
Dr. Urbanosky will perform a thorough physical exam to determine whether your injury is a Boutonniere Deformity. In addition to physical symptoms, she will ask questions regarding any recent trauma to the injured joint, including burns infections, or a history of rheumatoid arthritis (RA). Physical symptoms she will check for include:
• Inability to straighten the middle joint of the finger and the inability to bend the fingertip
• Tenderness, pain and swelling near the top of the middle joint of the affected finger
X-rays may be required to assess any broken bones attached to the central slip of tendon. Because a Boutonniere Deformity is only one of several injuries that result from a jammed finger, Dr. Urbanosky may also perform additional testing.
Prompt treatment by a skilled hand surgeon like Dr. Urbanosky is critical in a Boutonniere Deformity. Time truly is of the essence, as misdiagnosed or delayed treatment for Boutonniere Deformity can cause permanent deformity and long-term dysfunction. If left untreated for more than three weeks, it becomes more difficult to treat.
Non-surgical treatment of Boutonniere Deformity is preferred, but the cause of the deformity plays a role in determining treatment options. Splinting the injured joint to achieve adequate extension is the first step in both non-surgical and surgical treatment options. As with mallet finger, extension of the joint must be maintained continuously.
Surgery may be required if splinting techniques fail or when:
Surgical success is highly dependent on the efforts to straighten the joint prior to surgery. Thus, Dr. Urbanosky will make every effort to adequately extend the joint before choosing a surgical treatment. Typical surgical techniques to repair Boutonniere Deformity can include synovectomy, lateral band relocation dorsal to the axis of rotation, terminal tenotomy as well as central slip reconstruction. In some cases, surgery will not fully correct the condition.
If you think that you may be experiencing Boutonniere Deformity, contact Dr. Leah Urbanosky for a consultation: (815) 462-3474.
Cysts & Tumors
De Quervain's Tenosynovitis
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Traumatic Hand Injuries
Joint Replacement of the Hand
Mallet Finger (Baseball Finger)
Swan Neck Deformity
UCL Tear of the Thumb
Osteoarthritis of the Thumb