What is Boutonniere Finger?
Each finger, except for the thumb, is composed of three bones with ligaments connecting bone to bone and tendons connecting muscle to bone. There are several tendons that run along the side and top of the finger that allow for movement and keep the finger straight. When the tendon that runs along the top of the middle joint of the finger (the central slip of tendon) is torn the middle joint may push its way thru the tear causing the finger to bend. The tear in the tendon resembles a “boutonniere” which is French for buttonhole. Boutonniere Finger Deformity is characterized by flexion of the middle joint (proximal interphalangeal joint) and hyperextension of the fingertip (distal interphalangeal joint).
What causes Boutonniere Finger?
Boutonniere finger may occur as a result of a chronic condition like rheumatoid arthritis or after acute injury. Forceful “jamming” of a finger is the most common cause. However, any injury that produces a cut to the top of the finger may have the same result.
What are the symptoms of Boutonniere Finger?
The most prominent symptom is a finger in which the bent middle joint is unable to straighten out, while the fingertip is unable to flex. Some experience pain or swelling to the finger that persists. Signs of boutonniere finger generally occur within three weeks following injury but can appear immediately dependent on mechanism of injury.
In patients with rheumatoid arthritis the deformity occurs gradually over time and is categorized into three stages. It is important to seek medical treatment early to avoid the possibility of irreversible damage.
How is Boutonniere Finger diagnosed?
Diagnosis is relatively simple due to the distinctive nature of the deformity. After a complete history is taken the doctor will examine the affected digit. The finger may be manipulated to ascertain range of motion. X-rays may be ordered to determine if there are any bone fractures.
How is Boutonniere Finger treated?
Early intervention is essential to retaining full range of motion in the affected digit and non-surgical treatment is typically preferred. 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. The finger splint holds the digit in proper alignment while the tendon heals. The finger is immobilized for approximately 6 weeks. After this time some patients may be required to wear the splint at night. The doctor will likely recommend therapy and range of motion exercises during this time to restore flexibility.
Boutonniere finger caused by arthritis is managed based on the stage of the deformity. It is often treated by splinting the digit along with oral medications or injections. In some cases surgery may be indicated.
Surgical intervention may be required for several reasons. If the condition does not improve with splinting, the tendon is severed, there is a displaced bone fragment, or in cases of severe arthritis, surgery could be the only option. Generally the goal for surgery is to reduce pain, repair soft tissue damage and restore as much function as possible. Post operatively the finger will be splinted for 4-6 weeks. Therapy will then begin and continue for several months.
As with any surgical procedure, expectations should be discussed with the surgeon to insure congruency with typical surgical outcomes.
How can Dr. Knight help you with Boutonniere Deformity?
After confirming that you do, in fact, suffer from Boutonniere Deformity, it is important that you receive treatment as soon as possible, because if left untreated, this deformity can severely affect your manual dexterity. Once diagnosed, Dr. Knight will treat you as soon as possible in order to allay any complications that might arise, and to restore you to full mobility and dexterity, so that you can return to your life and work.
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