What is a boutonnière deformity?
Boutonnière deformity is a type of joint damage that happens mostly to fingers but can also happen to toes. It can happen because of an injury like a burn or a cut or can result from rheumatoid arthritis. The middle joint becomes stuck and the tip of the joint hyperextends.
What are the treatment options for Boutonniere deformity?
The diagnosis and management of boutonniere deformity is complex and requires an interprofessional team that includes a primary care provider, nurse practitioner, physical therapist, hand surgeon, and orthopedic surgeon. The goal of treatment is to regain full range of motion of the affected finger.
Does splinting help Boutonniere deformity?
The condition does not improve with splinting. Surgery can reduce pain and improve functioning, but it may not be able to fully correct the condition and make the finger look normal. If the boutonniere deformity remains untreated for more than 3 weeks, it becomes much more difficult to treat. To Top Last Reviewed December 2013
What are the conditions of finger deformity?
Diseases & Conditions. Boutonnière Deformity. Boutonnière deformity is the result of an injury to the tendons that straightens the middle joint of your finger. The result is that the middle joint of the injured finger will not straighten, while the fingertip bends back.
How do you fix a boutonniere deformity?
The most common treatment for boutonniere deformity involves stabilizing your finger with a splint that rests on the middle joint. The splint creates pressure to straighten and immobilize the finger.
What happens with boutonniere deformity?
A boutonniere deformity results from an injury to your top tendon. The injury stops the middle joint of your affected finger from straightening out, so it stays permanently bent. If left untreated, the deformity gets worse with time. The result is permanent joint damage and impaired finger function.
What is the tendon that is injured in boutonniere deformity?
A boutonniere deformity results when the triangular ligament and the central slip of the extensor tendon of a digit are disrupted. This disruption of the ligament and tendon will cause the lateral bands to displace volarly.
What arthritis causes boutonniere deformity?
Boutonniere deformity is most frequently caused by rheumatoid arthritis or from an injury where the finger suffers a forceful blow to the top of a bent middle joint.
Is boutonniere deformity a disability?
1. Entitlement to an increased evaluation for postoperative status, boutonniere deformity, right little finger (major extremity), currently evaluated as 10 percent disabling.
How long does a boutonniere deformity last?
Non-surgical If not treated within the first three weeks after injury the deformity may become permanent. Treatment is dependent on the origin of the deformity. In traumatic injury, splinting is the most common treatment.
Can you straighten boutonniere deformity?
In boutonnière deformity, the PIP joint can't be straightened.
Which splint used in boutonniere deformity?
A dynamic extension splint, known as a capener splint, is typically fabricated. It is a spring wire, three-point extension splint. It is designed to apply a small force to hold the joint at the end available extension range of movement (ROM), for long periods of time.
How do you get rheumatoid arthritis?
Rheumatoid arthritis is an autoimmune condition, which means it's caused by the immune system attacking healthy body tissue. However, it's not yet known what triggers this. Your immune system normally makes antibodies that attack bacteria and viruses, helping to fight infection.
Can bent arthritic fingers be fixed?
Yet surgery to repair the damage from hand arthritis is relatively rare. One reason is that finger surgery has a high complication and failure rate. It can also sacrifice mobility for pain relief. The two main surgical options for hand arthritis are fusion (arthrodesis) and total knuckle replacement (arthroplasty).
What does a boutonniere deformity look like?
In boutonnière deformity, an injury tears the tendon and a slit appears. If this situation isn't corrected, the middle of your finger will remain bent and the tip of your finger will stick out. It's called a boutonnière deformity because the slit in the tendon looks like a buttonhole with the bone showing.
Which structure is the most likely to be ruptured in an acute boutonniere deformity?
Definition. A Boutonniere deformity is a deformity of the fingers in which the proximal interphalangeal joint (PIP) is flexed and the distal interphalangeal joint (DIP) is hyperextended. It is an extensor tendon injury over zone III. It is also referred to as a "buttonhole deformity."
Can you be born with boutonniere deformity?
Boutonnière deformity is often the result of a blunt force injury to the finger, but can also be caused by chronic inflammation due to rheumatoid arthritis or a penetrating laceration. In rare cases, a mild Boutonnière deformity may be congenital (present at birth).
Can deformed fingers be straightened?
If you have severe joint deformity -- painful, crooked fingers and toes -- surgery may be an option. It won't cure your RA, but it can improve the deformity, ease pain, and help your joints work better. Some common types of surgery include: Synovectomy -- removal of the lining of the joint, called the synovium.
Why do you need to treat a boutonnière deformity?
Boutonnière deformity must be treated early to help you retain the full range of motion in the finger.
What is the cause of a boutonnière tear?
Cause. Boutonnière deformity is generally caused by a forceful blow to the top (dorsal) side of a bent (flexed) middle joint of a finger. It also can be caused by a cut on the top of the finger, which can sever the central slip (tendon) from its attachment to the bone. The tear looks like a buttonhole ("boutonnière" in French).
How long does it take for boutonnière deformity to develop?
Signs of boutonnière deformity can develop immediately following an injury to the finger or may develop a week to 3 weeks later. The finger at the middle joint cannot be straightened and the fingertip cannot be bent. Swelling and pain occur and continue on the top of the middle joint of the finger. To Top.
What is the cause of a deformity in the middle of the finger?
Boutonnière deformity is the result of an injury to the tendons that straightens the middle joint of your finger. The result is that the middle joint of the injured finger will not straighten, while the fingertip bends back.
Is boutonnière deformity surgical?
While nonsurgical treatment of boutonnière deformity is preferred, surgery is an option in certain cases, such as when:
Why does my boutonniere deform?
Causes and symptoms. A boutonniere deformity can occur due to an injury or an underlying health condition. Damage to the tendon that runs along the back of the finger or thumb joint is usually the primary cause. The injury usually occurs at the middle phalanx extensor tendon, which is located at the bottom of the tendon.
How to diagnose boutonniere deformity?
To diagnose a boutonniere deformity, a doctor will physically examine the fingers and hand.
What causes a thumb to bend inward?
Exercises. Summary. Boutonniere deformity causes the middle joint in a finger or thumb to bend inward and the end joint to bend outward. It is possible to correct this using a splint, but sometimes, other treatments are necessary. Boutonniere deformities can result from injuries to the tendons that run along the backs of the fingers or thumbs.
What is the best treatment for a deformity in the tendons?
If the deformity is due to a condition, it may require more than just a splint. For example, a doctor may prescribe corticosteroids to reduce inflammation in the tendons.
What happens when you cut a tendon?
During surgery, a health professional may cut an area of the tendon to release pressure on the joint. They may also insert a screw or wiring to straighten the joints, similar to a splint. This fuses the joint in a fixed position.
Can boutonniere deformity affect thumb?
It can affect any finger or the thumb. It is easy to confuse a boutonniere deformity with a swan neck deformity. A swan neck deformity occurs when the base joint of the finger, rather than the middle joint, bends inward.
Can a boutonniere deformity cause a finger to bend?
It may also get worse over time. Boutonniere deformities can lead to problems using the finger.
What is boutonniere deformity?
Boutonniere deformity describes a medical condition in which the finger is flexed at the proximal interphalangeal joint (PIP), and there is hyperextension at the distal interphalangeal joint (DIP). This is usually a result of trauma in the acute setting and is caused by force applied to the top of a bent middle joint of a finger. There is a direct injury to the central slip that damages the extensor function of the affected digit. A boutonniere deformity can also result from a laceration on the top of a finger, which can sever the tendon and detach it from the bone. It can also happen if the patient would suffer a full-thickness burn resulting in direct injury to the central slip. This activity describes the pathophysiology, causes, and presentation of boutonniere deformity and highlights the role of the interprofessional team in its management.
What is the best treatment for boutonniere deformity?
The treatment options for a boutonniere deformity if it represents a chronic sequela of rheumatoid arthritis. The classes of medications to treat rheumatoid arthritis are disease-modifying anti-rheumatic drugs (DMARDs), biologic response modifiers, glucocorticoids, nonsteroidal anti-inflammatory medications (NSAIDs), and analgesics. DMARDs are used to delay the progression of rheumatoid arthritis. DMARDs have different mechanisms of action and are often used in combination therapy. Although the mechanism of action varies, they have a similar impact on the disease process. Biologic response modifiers are genetically engineered and work by interrupting a patient’s immune system signals that are responsible for tissue damage. Most of these medications attempt to interfere with the activity of tumor necrosis factor. Glucocorticoids are used to reduce inflammation and also to curb the autoimmune activity. They are often used in conjunction with DMARDs. NSAIDs can aid with pain control, swelling, and inflammation, but do not affect slowing the disease process. Analgesics are used to control pain only.
How long does it take for a deformity to manifest?
A deformity can take several weeks to manifest.
Is digital casting good for boutonniere deformity?
Preventing progression to a boutonniere deformity is the chief goal of good treatment outcomes. Serial digital casting has been shown to be moderately successful. [11] Depending on severity of the injury, a complete recovery with relation to range of motion is infrequently seen. [11]
How to fix boutonnière deformity?
Splint. The most common treatment for boutonnière deformity is a finger splint. This is a stiff sleeve that goes over the finger and is secured with tape or Velcro. The splint helps keeps your finger straight for up to 6 weeks, giving the tendon a chance to heal. You may also need to wear a protective splint while playing sports for several weeks more.
Why is my boutonniere deformity called a jammed finger?
This condition can happen because of rheumatoid arthritis (RA) or osteoarthritis. It can also happen if the tendons in your finger are hit or cut (for instance, if your hand gets stepped on or crushed in a door). When this happens, the boutonniere deformity can be called a “jammed finger”. Similar Problems.
What is mallet finger?
Mallet finger is a similar finger deformity that can be caused when a ball or other object hits that tip of your finger or thumb. Sometimes, this blow can be strong enough to tear the tendon that straightens the finger, which can make it bend without you being able to straighten it. Symptoms.
Why does my hand deform?
The deformity can be caused by injuries to your hand. For example, instance, your finger could get hit while your finger joint is bent, or you could have a cut in the top of your finger joint that goes through the tendon. Sports injuries can also cause this problem. Rheumatoid arthritis. Rheumatoid arthritis, or RA, ...
What tests can you take to check for boutonniere deformity?
Your healthcare provider might also order imaging tests, like x-rays, to take pictures of your finger and look for any other problems like broken bones or slipped tendons. These tests will help your symptoms are caused by boutonniere deformity or a similar injury.
What causes a finger to deform?
Rheumatoid arthritis. Rheumatoid arthritis, or RA, is an autoimmune disease that causes damage to your joints and connective tissues in your body. RA can cause inflammation that can hurt the tendon and middle joints of your finger, causing the deformity. Diagnosis and Tests.
Can boutonnière deformity cause permanent damage?
Since the boutonnière deformity is caused by damage to the hand, you might also have other symptoms or injuries that also need a healthcare provider’s care. Find a Provider.
