Blog Post October 2021: Boutonniere Deformity

Not Your Average Prom Date!

A boutonniere deformity is not a bundle of flowers to pin on your date’s jacket but a tendon injury on your finger! On the back of each finger is the mechanism by which each finger is straightened, or extended, called the ‘extensor mechanism’. The extensor mechanism is made up of ligaments and tendons that aid in motion of the fingers and keeping bones and joints aligned to allow for normal motion.

When a tear occurs in the central slip of the extensor mechanism, often from a “jammed finger”, dislocation, laceration or even an inflammatory disease (looking at you arthritis) the middle knuckle, the proximal interphalangeal joint (PIP) results in a boutonniere position or deformity. This position appears as hyperextension of the PIP joint or inability to straighten the finger. This joint position is simple due to physics! The tension by which the PIP joint is kept straight is due to the central slip and the lateral bands that run alongside the PIP joint. When left unchecked, the lateral bands are forced below the joint—volarly—toward the palm side of the hand, creating the hyperextension position.

Knowing the anatomy and injury are important factors that aid in comprehensive rehabilitation. At Ascend Hand Therapy LLC hand therapists provide specialized care for conservative treatment and post operative treatment of boutonniere injuries.

Conservative treatment may look like custom splinting, swelling and pain management, range of motion and strengthening per patient healing. Additionally, post operative care would include wound and scar management, pain management, range of motion and strengthening.

References:
Boutonniere Deformity 2018.pdf (asht.org)
Finger Deformities | Rehabilitation of the Hand and Upper Extremity (inkling.com)
Boutonnière Deformity - OrthoInfo - AAOS

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