MANUAL MINORS
Boutonniere deformity is an injury affecting the extensor tendons of the finger, specifically the insertion of the extensor tendon at the proximal interphalangeal (PIP) joint. It occurs when the extensor tendon tears or displaces, causing forced flexion of the PIP joint and hyperextension of the distal interphalangeal (DIP) joint. This injury may result from direct trauma, cuts, or inflammatory conditions like rheumatoid arthritis.
Diagnosis
Diagnosis is based on clinical observation: the affected finger shows flexion at the PIP joint and abnormal extension at the distal joint. Patients may experience pain, swelling, and difficulty extending the PIP joint. X-rays are useful to rule out associated fractures or dislocations.
Differential Diagnosis
Condition | Key Differences |
|---|---|
Mallet finger | Inability to extend the distal phalanx without PIP joint involvement. |
Swan neck deformity | Hyperextension of the PIP joint and flexion of the DIP joint, opposite of Boutonniere deformity. |
Phalanx fracture | Localised bone pain with visible fracture on X-rays. |
PIP joint subluxation | Partial joint displacement without primary involvement of the extensor tendons. |
Emergency Management
Immediate immobilisation of the finger in extension with a dynamic or aluminium splint to allow rest for the extensor tendon.
Application of ice to reduce swelling and administration of analgesics for pain relief.
X-rays to rule out associated fractures or dislocations.
Referral to a specialist if a complete tendon rupture is suspected or immobilisation fails.
Definitive Treatment
Initial treatment includes using a splint to maintain the PIP joint in extension for 6-8 weeks. If the deformity does not resolve with conservative management, or if the injury is chronic or severe, surgery may be required to repair the tendon. Rehabilitation with physical therapy is essential after treatment to restore mobility, strength, and function of the affected finger.
Comments