Boutonnière deformity is a hand condition that affects the fingers, causing an abnormal bend in the joint just below the fingertip. This joint is called the proximal interphalangeal (PIP) joint. This condition results from injury to the extensor tendon, which runs along the top of the finger and helps extend it. When the tendon is damaged, the PIP joint bends downwards while the tip of the finger extends upwards – resembling the shape of a buttonhole, or “boutonnière” in French. This condition may occur due to trauma, rheumatoid arthritis, or other degenerative diseases affecting the joints and tendons in the hand. Patients with boutonnière deformity may have trouble fully straightening their fingers, which can impact daily activities like grasping objects or typing. Early diagnosis and treatment are crucial for preventing long-term pain, stiffness, and possible deformity. Our hand specialists at OrthoGeorgia provide comprehensive care for boutonnière deformity and other hand or upper extremity conditions to help restore hand function and improve quality of life. Keep reading to learn more!
What are the Symptoms of Boutonnière Deformity?
The primary symptom of boutonnière deformity is the inability to fully straighten the middle joint of the finger. The condition usually progresses through various stages, with symptoms worsening over time if left untreated. Common symptoms include:
Downward bend in the PIP joint: The middle joint of the finger may bend downward, making it challenging to straighten the finger
Upward tilt at the distal interphalangeal (DIP) joint: The fingertip may bend backward due to tension in the extensor tendon
Difficulty with grip and hand strength: Many people find it hard to grip objects, affecting their ability to perform everyday tasks
Limited range of motion: The finger may lose its ability to extend or flex fully over time, leading to reduced hand function
Pain and swelling: The PIP joint can become swollen and painful, especially with movement
In advanced cases, the deformity can become fixed, making it nearly impossible to straighten the finger, even with assistance. Early intervention is essential to minimizing the risk of long-term deformity and disability in the hand.
How is a Boutonnière Deformity Diagnosed?
Diagnosing boutonnière deformity involves several steps. When you meet with one of our hand specialists at OrthoGeorgia, they will likely go through the following process to determine what exactly is causing your symptoms, whether it be boutonnière deformity or another hand condition or injury.
Physical Examination: The physician assesses the finger’s position, range of motion, and any visible deformity or swelling. They may ask the patient to try certain finger movements to detect any functional restrictions.
Medical History: A complete history of any hand trauma, joint disease, or symptoms related to rheumatoid arthritis or other autoimmune conditions provides valuable insights into the potential cause of symptoms.
X-rays:Imaging is usually used to rule out bone or joint injuries and to confirm the deformity. X-rays, which are performed at all OrthoGeorgia clinic locations, can show joint alignment, fractures, and degenerative changes that could contribute to boutonnière deformity.
MRI or Ultrasound: In some complex cases, advanced imaging may be recommended to evaluate the extent of tendon damage and soft tissue involvement.
A complete and comprehensive diagnosis ensures an appropriate treatment plan to address both the symptoms and underlying causes of boutonnière deformity.
Boutonnière Deformity Treatment in Central GA
At OrthoGeorgia, our experienced orthopedic specialists offer a wide range of treatments for boutonnière deformity. Your specific treatment approach will depend on the severity of the deformity, its cause, and your overall health and activity levels. OrthoGeorgia’s hand specialists are trained in both surgical and conservative treatments, working with patients to create a care plan that aligns with their goals.
Nonsurgical Treatment for Boutonnière Deformity
In many cases, boutonnière deformity can be managed with nonsurgical treatments, especially if the condition is diagnosed early. The most common nonsurgical treatment options for this condition include:
Splinting: The initial treatment for boutonnière deformity usually involves wearing a splint that keeps the PIP joint in an extended position. This allows the damaged tendon to heal while maintaining the correct joint alignment. Patients typically wear the splint for 4-6 weeks, depending on the severity of the injury.
Hand therapy:Physical or occupational therapy can be beneficial for restoring range of motion, flexibility, and strength in the hand and fingers. Our specialized hand therapists at OrthoGeorgia work with patients to create customized exercise programs to improve finger function and reduce stiffness.
Anti-inflammatory Medications: Over-the-counter or prescription NSAIDs can help reduce pain and inflammation in the affected joint, making daily activities more comfortable.
Steroid Injection: In cases of inflammatory conditions such as rheumatoid arthritis, corticosteroid injections can minimize pain and swelling. However, these injections may not be appropriate for all patients, so consulting with a specialist is important.
Nonsurgical treatments can be very effective, especially when started early. However, if symptoms continue or worsen, surgery may be recommended.
Boutonnière Deformity Surgery
Surgery may be necessary for patients with severe or longstanding boutonnière deformity, especially if nonsurgical methods have not been effective in reducing symptoms. Surgical options are catered to each patient’s individual needs, with the ultimate goal of restoring function and alignment of the finger. Surgical options for boutonnière deformity in Central GA include:
Tendon Repair: If the deformity results from a tendon injury, surgical repair can establish tendon function. The surgeon carefully reconnects or reconstructs the damaged tendon to restore its ability to extend the finger.
Joint Realignment: In cases where joint damage has occurred, realignment surgery may be necessary. This procedure can involve removing damaged tissue, resetting the joint, or fusing joints together (in severe cases).
Arthroplasty or Joint Replacement: For patients with significant joint damage, joint replacement may be an option. Arthroplasty involves replacing the damaged joint with an artificial one, which can improve both comfort and function.
Rehabilitation: Post-surgery, rehabilitation is crucial to regain strength, flexibility, and range of motion. OrthoGeorgia’s certified hand therapists support patients through a structured rehabilitation program to ensure the best possible outcomes.
Surgical intervention can restore hand function and provide long-term relief, helping patients return to their daily routines with minimal discomfort.
Other Hand and Upper Extremity Conditions We Treat at OrthoGeorgia
At OrthoGeorgia, our orthopedic specialists in Central GA are committed to providing comprehensive care for a wide range of hand and upper extremity conditions. If you believe you have a deformity or are experiencing painful symptoms in the hand, scheduling an evaluation with a hand specialist is key to ensuring that you can continue to do the things you love. Beyond boutonnière deformity, we also diagnose and treat the following hand and upper extremity conditions and injuries.
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