Introduction A boutonniere deformity is the name of a deformity of the hand caused by an injury to the central slip , resulting in PIP flexion and DIP extension.
A boutonniere deformity is the name of a deformity of the hand caused by an injury to the central slip , resulting in PIP flexion and DIP extension. There are many etiologies of a boutonniere deformity, but the most common two are chronic inflammatory diseases ( rheumatoid arthritis ) and traumatic injury. The most common etiologies of trauma include open laceration of the central slip tendon, blunt trauma, and volar dislocation of the PIP joint (1/2).
The deformity is rather simple to visualize on exam, however it is commonly mistreated or misdiagnosed, leading to delayed treatment and often permanent deformity and/or dysfunction. Boutonniere Deformity Anatomy and Injury First and foremost, this is not to be confused with a hyperextension injury (jammed finger) causing fixed flexion at the PIP joint. A boutonniere deformity will have extension at the DIP.
To understand the mechanism of the deformity, it is important to understand the anatomy of the extensor tendons of the hand. As the extensor digitorum tendon travels distally, it divides into the lateral band and central slip tendon, which attaches to the proximal portion of the middle phalanx. After central slip tendon injury, there is migration of the lateral bands which causes flexion at the PIP joint and extension at the DIP.
Central Slip Anatomy Diagnosis The Elson Test is the most sensitive test for acute boutonniere deformity (4/5). Providers need to flex the PIP to 90 degrees and then ask the patient to extend at the DIP. Under normal conditions with an intact central slip tendon, the DIP cannot be actively extended into plane with the PIP.
In the circumstances of central slip tendon injury, the patient is abnormally able to extend at the PIP secondary to a central slip injury. Https://www.youtube.com/watch?v=2rkr2NOgTuQ Elson Test Plain radiographs of the finger should be obtained in all cases to see subtle DIP hyperextension that can be difficult to detect on exam and to rule out fracture which can complicate management and treatment. Treatment Acute and closed injury should be managed with full time splinting of the PIP in extension for 4-8 weeks with active DIP flexion exercises multiple times daily.
If you are experiencing symptoms that may be related to the traumatic boutonniere deformity, it is important to see a sports medicine physician. Early evaluation and treatment typically lead to better outcomes. Do not ignore pain or symptoms that are limiting your activity.
*This article is for educational purposes only and does not substitute for professional medical advice. Always consult a qualified healthcare provider.*
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