This article is about the Boutonnière Finger Deformity.
It includes the causes, diagnosis and treatment. The information can also be seen in part of the following video.
A Boutonnière Deformity is the opposite of a swan neck. So instead of hyperextension of the PIP joint, we now have a bent position of the PIP. And instead of the DIP joint being flexed as in a swan neck, it’s now hyperextended.
A boutonniere deformity is caused by an injury to part of the extensor tendon called the central slip. This part of the tendon is responsible for straightening the PIP joint and without it, the PIP joint falls into a bent position and you won’t be able to straighten the finger.
The injury creates a hole in the central slip which the head of the proximal phalanx bone can push through, like a button pushing through a button hole, which is where it gets its name from - boutonnière means ‘button hole’ in French.
If you’ve just had this injury then its usually treated in a splint which holds the PIP joint in a straight position for at least 8 weeks and it must be worn all the time day and night in order to give the torn tendon every chance of healing.
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| A Capener Splint (Product Link) |
While in the splint you will be encouraged to move and exercise the knuckle joint (MCP joint) and the end joint (DIP joint), but the middle joint (PIP joint) must be kept straight all the time. The type of splint used for this injury is called a capener splint. The splinting regime is usually done under the supervision of a hand therapist who can then supervise your rehab in order to give your finger every chance to heal properly. Because if it doesn’t heal, then you’re going to need to see a hand surgeon about the option of tendon repair.
If you’ve left it too long after the injury, and particularly if the PIP joint has become stiff so it doesn’t move any more, then your options are limited. Your choices are then to either leave it alone and cope with the finger as it is, or to discuss your options with a hand surgeon, which is likely to mean PIP joint fusion or joint replacement.
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This article provides general information related to various medical conditions and their treatment. It is intended for informational purposes only and not a substitute for professional advice, diagnosis or treatment provided by a doctor or other qualified health care professional. The information provided does not constitute personal advice or guarantee of outcome and should not be used to diagnose yourself or others. You should never ignore advice provided by a health care professional because of something you have seen or read on this website. You should always consult a doctor or other qualified health care professional for personal medical advice.