June 16, 2021 5 min read
Answer a fun quick question about Boutonniere Deformity, learn more about what defines this particular deformity and find some helpful tips on the best hand therapy treatment for Boutonnière deformity.
Hyperflexion of the PIPJ with hyperextension of the DIPJ is known as what?a) Mallet finger
Answer: d) Boutonnière deformity
A Boutonniere deformity results from a Zone III extensor tendon (central slip) injury, and presents as PIP flexion and DIP hyper-extension.
It gets its name from the "button-hole" appearance ("Boutonniere" in French).
It is caused by disruption of the central slip over the PIP joint, which can happen in several ways, such as laceration, closed rupture / traumatic avulsion (jammed finger), or capsular distension
(e.g. in rheumatoid arthritis).
The best way to test the central slip is "Elson's test" (even before any deformity becomes evident)
If there is a closed injury (i.e. not a laceration) and you are seeing the client in the first 4/52 post injury:
Surgery may be required if there is an acute displaced avulsion fracture or an open wound, or in chronic injuries that have full PROM but can still not actively extend the PIPJ, or in a rheumatoid patient with a painful, stiff, arthritic PIP joint.
Post-op hand therapy depends on your surgeon’s protocols, but usually:
This blog is a discussion format. We have listed our views above but would love to know what you think, what your comments are or how you best treat Boutonniere Deformity in your practice. Feel free to email us at firstname.lastname@example.org
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