What is a Boutonniere Deformity?
Boutonniere deformity is a deformity in which the middle joint of the finger (known as the PIP, or Proximal Inter-Phalangeal joint) is permanently bent towards the hand, while the outermost joint, or DIP (Distal Inter-Phalangeal joint) is bent away from the hand. This happens as a result of a tear in the tendon sheet along the top of the PIP joint. The tendon can no longer effectively extend the PIP joint and then over compensates by over extending the DIP joint.
What causes Boutonniere Deformity?
Boutonniere Deformity is most often caused by an injury, typically a hard blow to the outstretched finger or “jamming”, but can also occur as a result of rheumatoid arthritis.
What are symptoms of Boutonniere Deformity?
As mentioned, Boutonniere finger presents as a very distinct malformation, so it is relatively easy to diagnose once it has become apparent. It does not, however, immediately present, and may take as long as one to three weeks before the finger begins to show signs of the malformation. Even before the finger takes on the characteristic form, the problem may be indicated by swelling and pain in the joints of the affected finger.
How to Diagnose Boutonniere Deformity.
Because of the characteristic presentation of the deformity, the doctor will no doubt be able to ascertain quickly the nature of the problem, but, depending on the cause of the injury, there may be various related issues. If the Boutonniere Finger is the result of Rheumatoid arthritis, then treatment is relatively straightforward, but if it is the result of an injury, the doctor must take care to ascertain if any more damage has been done to the surrounding hand. If any bones are broken, or additional tendons damaged, it may indicate a larger problem.
Non-surgical treatment of Boutonniere Deformity.
The most common non-surgical treatment for Boutonniere Deformity is for the injured patient to wear a special splint on the affected finger. This splint is designed specifically to hold the bent and injured finger in proper position, so that the tendon will heal correctly, without any gaps or additional tearing. This splint will also help strengthen the joint as it heals. The length of time can vary, but generally, the finger should be immobilized in the splint from 3 to 6 weeks. In addition, even after the splint is removed, you may still be advised to wear it at night, to further strengthen the joint. Once the splint is removed, a regimen of exercise and therapy are recommended, in order to restore the joint to its original flexibility and return it to full use.
Surgical treatment of Boutonniere Deformity.
Generally, a nonsurgical treatment is preferred, but may not be possible in certain circumstances. These cases include the severing of the tendon, displacement of bone or fragmentation, as well as if the deformity is a result of rheumatoid arthritis, or if splinting the finger proves ineffectual. If necessary, Dr. Knight will perform a minimally invasive procedure along the top of the finger, reattaching the tendon to its original position, as well as moving the bone back into place and stitching any tears that may have occurred in the tendon prior to diagnosis.
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.
Boutonniere Deformity Animation Video
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