Boutonnière deformity is a medical condition caused by an injury to the tendons that straighten your finger’s middle joint. For those who are afflicted by this condition, the middle joint of your finger bends in, and the outermost joint bends out.

The abnormality may worsen if not addressed on time, resulting in irreversible deformity and decreased functionality.

What is Boutonniere Deformity?

Boutonniere deformity of the fingers is a medical condition where the proximal interphalangeal joint (PIP) is flexed and the distal interphalangeal joint (DIP) is hyperextended. It is also known as ‘buttonhole deformity’ and ‘center slip’. Boutonniere deformity can affect any finger or thumb. It is often caused by rheumatoid arthritis but can also follow injuries.

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What are the common symptoms of Boutonniere Deformity?

The initial signs of a Boutonniere deformity can appear either immediately after an accident or manifest after a period of time. If the underlying cause of the deformity is arthritis, then it usually develops gradually over time. You will first notice that you are unable to straighten your fingers completely. In addition, the tip of your finger does not bend in toward the palm of your hand, no matter how hard you try. Swelling or soreness is also possible.

When should you seek medical attention? 

Boutonniere deformity is just one of the many injuries that can occur as a result of a “jammed finger”. If you are affected by this condition, you should consult your Apollo doctor for a thorough diagnosis and treatment options.

To begin with, the fingers will be examined by your doctor. He/she will ask you to bend the fingertip and straighten the affected finger. Basis his/her observations a diagnosis will be made or further tests recommended. Broken bones linked to the central slip of the tendon may require X-rays to be accurately identified.

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What causes Boutonniere Deformity?

Boutonniere deformity can be caused by a number of factors: 

• Arthritis-related inflammation can damage your tendons and cause your fingers to become permanently twisted 
• Any sort of force or impact that strikes your finger when it is already flexed at the middle joint, causing that joint to be injured 
• Tendon damage can occur if the skin on your finger bursts opens due to a deep cut. The rip resembles a buttonhole, which is referred to as a “boutonniere” in French. 

The following are risk factors for developing Boutonniere deformity:

• Rheumatoid arthritis 
• Dupuytren’s contracture 
• Contact sports such as football, wrestling, basketball, and baseball 

What are the complications associated with leaving Boutonniere Deformity untreated?

Each of your fingers has many tendons that work in tandem to bend. Tendons run on both sides of your fingers and on top of them as well. Damage to your top tendon causes a boutonniere deformity.

The injury prevents the affected finger’s middle joint from straightening out, causing it to remain permanently bent. If the deformity is not addressed, it will worsen over time. 

What are the treatment options available?

Boutonnière deformity must be addressed early in order to retain your fingers’ complete range of motion.

Medical Treatment may include:

• Splints: 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. 

• Stretching exercises: This activity will be recommended by your Apollo doctor to improve the strength and flexibility of your fingers.
• Protective splinting or taping may be required for several weeks after the splint is removed if you participate in sports.

Oral medicines, corticosteroid injections, and splinting may be used to address boutonnière deformity caused by arthritis.

Surgical Treatment – While noninvasive therapy for boutonnière deformity is recommended, surgery may be necessary for certain cases, such as when:

• Rheumatoid arthritis is the cause of malformation
• A tendon has been severed
• The typical position of a bone fragment has shifted
• Splinting has no effect on the condition

There are numerous different approaches to treat boutonniere deformity surgically, such as:

• Cutting and sewing damaged tendons together 
• Cutting and releasing tendons
• using wire or small screws to straighten the joints
• using a piece of tendon from another place

How do you prevent Boutonniere Deformity?

A few preventive actions, particularly for people who participate in sports, can help in preventing boutonniere deformity, such as:

• Do Stretching and warm-up exercises to ensure that the fingers move uniformly and are flexible, as well as to prevent them from becoming overly stressed.
• When participating in sports or other similar activities, wear the appropriate protective equipment.
• In case of a pre-existing injury, wear a splint for a few days to stop the injury from getting worse

A Note from Apollo Hospitals/Apollo Group

Rheumatoid arthritis, osteoarthritis, and finger traumas are all known to cause boutonniere deformity. If this condition is diagnosed early, it can be treated with non-surgical methods, such as wearing a splint. 

In more severe cases, surgery to restore your finger’s tendons or to straighten the middle joint may be required.

Frequently Asked Questions

1. What’s the difference between swan neck deformity and boutonniere deformity?

Boutonniere deformity is widely confused with another joint deformity called swan neck deformity. In this deformity, the base of your finger, and not the middle joint, bend in or flexes toward your hand. The middle joint is straightened or extended outward similar to how a swan looks like. 

2. Does the angle of the deformed joint determine the severity of the condition?

Yes, if the angle of the deformed joint is less than 15°, your doctor would suggest wearing a splint. For angles that are more than 15°, other treatment options involving surgery would be suggested.

3. Is tendon surgery effective in treating Boutonniere deformity?

Tendon surgery to treat Boutonniere deformity is usually recommended when the patient is able to move the joint only a little bit or not at all, and this type of surgery is effective in treating severe symptoms. 

Reference:

1. Boutonniere Deformity Treatment: Splints, Surgery, and Recovery (healthline.com)