What is a Boutonniere deformity?
There are tendons that run on the side and top of the finger that bend and straighten the finger. The tendon on the top attaches to the middle finger bone (the central slip ). Boutonnière deformity is caused by injury to the top (dorsal) side of a flexed middle finger joint. A cut on the top of the finger can sever the tendon from its attachment to the bone. In some cases, the bone actually can pop through the opening. Boutonnière deformities may also be caused by arthritis. Unless this is treated promptly, the deformity becomes permanent.
What are the symptoms?
- The finger middle joint cannot be straightened and the fingertip cannot be bent.
- Swelling and pain on the top of the middle finger joint..
- The deformity may develop immediately or take up to 3 weeks after the injury.
What medical tests will I need?
- X-Rays: to rule out any abnormal bone structures that might be causing your symptoms.
How is it treated?
- Splints: This keeps the ends of the tendon together as it heals, and allows the end joint of the finger to bend.
- Occupational Therapy: formal exercises to stretch and increase the range of motion in the finger.
- Arthritis: Boutonnière deformity caused by arthritis may be treated with oral medications or corticosteroid injections.
- Surgery: this is an option in severe deformity from rheumatoid arthritis, or if the tendon is cut. If the deformity has not been treated for more several weeks, surgery is less likely to be successful.
What do I need to know about surgery?
- You will be contacted within 2 weeks of your pre-op appointment for pricing and scheduling.
- The surgery will last less than 90 minutes (depending on the injury) and you will go home the same day.
- Your surgeon will make an incision on the top (dorsal) of your finger.
- At your 2 week follow up visit, the sutures and bandage will be removed, and you will begin scar massage.
- You will have a splint for 6-12 weeks that will keep the repaired part of the finger from moving, but will allow you to move the very tip of the finger.
- You will not be able to lift anything with the affected hand for 8 weeks.
- You may require occupational therapy after surgery to help restore your range of motion and strength.