Boutonniere Deformity

Definition

Disruption of the central slip/band that creates a flexion posture of the proximal interphalangeal joint (middle joint) with concurrent hyperextension posture of the distal interphalangeal joint (furthest joint) due to pathology at the central slip and triangular ligaments.

Symptoms

Pain and deformity of the finger
Inability to flex the DIP (tip) of finger and extend (straighten) the PIP (middle joint).

Pathology

Disruption of the central slip and triangular ligaments.
Traumatic (laceration/cut, direct blow to tip of finger).
Degenerative (chronic inflammation, Rheumatoid arthritis)
Unopposed lumbricals and collateral bands pull the middle joint (PIP) into flexion and the last joint (DIP) into extension.
Pathology creates deformity of the finger and lack of or inability to extend middle joint

Treatment

Non-surgical

Early management with strict splinting of the PIP (middle) joint for 3-6 weeks.
Occupation Therapy

Surgical

Indicated when non-operative treatment fails.
Open tendon injuries and/or PIP (middle) joint injuries that result in an extension deficit of 30 degrees or greater.