Boutonniere Deformity

Boutonniere deformity is a condition that affects the fingers, causing the middle joint (proximal interphalangeal joint) to bend downwards (flex) while the outermost joint (distal interphalangeal joint) bends backwards (hyperextends). This deformity typically results from injury or chronic conditions affecting the tendons in the fingers.

Causes:

• Trauma: Direct injury to the top of the finger, such as a cut or blow, that damages the central slip of the extensor tendon.
• Rheumatoid Arthritis: Chronic inflammation can weaken and damage the tendons and joints, leading to deformities.
• Other Conditions: Psoriatic arthritis and osteoarthritis can also contribute to the development of boutonniere deformity.

Symptoms:

• Inability to straighten the middle joint of the finger
• The finger appears bent at the middle joint and extended at the tip
• Pain and swelling at the middle joint
• Stiffness and difficulty in finger movement

Diagnosis:

• Physical Examination: Assessment of finger position, range of motion, and the ability to straighten the finger.
• Imaging Tests: X-rays to evaluate the extent of joint damage or misalignment and to rule out fractures.

Treatment:

1. Non-Surgical Treatments:

   • Splinting: Wearing a splint to keep the middle joint in a straight position, typically for 6-8 weeks, to allow the tendon to heal.
   • Physical Therapy: Exercises to maintain flexibility and strength in the finger and prevent stiffness.
   • Medications: Anti-inflammatory drugs to reduce pain and swelling, particularly if caused by arthritis.

2. Surgical Treatments:

   • Tendon Repair: Surgically repairing the damaged tendon if non-surgical methods fail or if the injury is severe.
   • Joint Surgery: In cases with significant joint damage, surgery may involve joint realignment, fusion, or replacement.

Prognosis: Early treatment of boutonniere deformity often results in good outcomes, especially with timely splinting and physical therapy. Chronic or untreated cases may lead to permanent deformity and loss of function. Regular follow-up and adherence to treatment plans are crucial for recovery and preventing recurrence. In cases associated with rheumatoid arthritis or other chronic conditions, managing the underlying disease is essential to prevent further joint and tendon damage.