What is boutonniere deformity?

A boutonniere deformity is a hand condition where the finger joint that sits nearest the knuckle is bent toward the palm while the farthest finger joint is bent in the opposite direction.

Causes of boutonniere deformity

Boutonniere deformity is most frequently caused by rheumatoid arthritis or from an injury where the finger suffers a forceful blow to the top of a bent middle joint.

Other causes of boutonniere deformities are:

  • Severe cut — a severe cut to the top of the finger can cause the tendon to be severed from the bone. In some severe cases, the bone may come out through the cut
  • Genetic conditions — genetic conditions such as Ehlers-Danlos syndrome can cause a boutonniere deformity.
  • Osteoarthritis

Risk factors for boutonniere deformity

Risk factors for developing a boutonniere deformity include:

  • Rheumatoid arthritis
  • Dupuytren’s contracture
  • Participating in direct contact sports, such as football, wrestling, basketball and baseball

Symptoms of boutonniere deformity

The most common symptom of a boutonniere deformity is pain on top of the middle finger joint after experiencing an injury. The pain can present as long as three weeks after the incident.

Other symptoms of boutonniere’s deformity include:

  • Inability to straighten the finger at the middle joint
  • Inability to bend the finger down
  • Swelling on the finger joint
  • Patients who suffer from rheumatoid arthritis have constant inflammation in the middle joint of the finger

Diagnosis of boutonniere deformity

Boutonniere deformities are diagnosed in a physical exam with your orthopedic physician. The physician will exam the hands and fingers as well as order an x-ray to determine if you have a fracture.

Consult your physician right away if you think you have boutonniere’s deformity to start the correct treatment protocol. There are several other finger injuries that appear similar to boutonniere deformities.

Treatments for boutonniere deformity

It is important to treat a boutonniere deformity right away to avoid permanent damage to your finger. 

A boutonniere deformity is typically treated with splints or braces that are placed on the finger joint for four to six weeks.

If pain and symptoms are not relieved after the initial splinting, other treatment options for a boutonniere deformity include:

  • Nighttime splinting or bracing
  • Steroid injections
  • Physical therapy & rehabilitation
  • Surgery

Most patients will not need to have surgery to correct boutonniere deformities. Typically, patients who need surgery are those who suffer from rheumatoid arthritis, have displaced bone fragments, have a severed tendon or those patients where splinting failed.

Recovery from boutonniere deformity

Recovery from a boutonniere deformity takes anywhere from three weeks to many months depending on the severity of the condition.

If the initial treatment was ineffective, a physician may prescribe additional therapy such as night splinting or bracing.

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