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Boutonniere Deformity Workup

  • Author: Wayne Reizner, MD; Chief Editor: Harris Gellman, MD  more...
 
Updated: Jan 11, 2016
 

Imaging Studies

A boutonnière (buttonhole) deformity (BD) can be assessed by means of plain radiography (see the image below). The lateral radiograph of the affected digit can define the degree of hyperextension at the distal interphalangeal (DIP) joint. Furthermore, radiographs may identify any osseous abnormality.

Radiographic evidence of boutonnière deformities. Radiographic evidence of boutonnière deformities. Image courtesy of Radiopaedia.org; case by Dr Aditya Shetty (http://radiopaedia.org/cases/rheumatoid-arthritis-13).
 
 
Contributor Information and Disclosures
Author

Wayne Reizner, MD Resident Physician, Department of Orthopedic Surgery, Mount Sinai St Luke’s-Roosevelt

Disclosure: Nothing to disclose.

Coauthor(s)

David A Forsh, MD Chief, Orthopedic Trauma Surgery, Assistant Professor, Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai

David A Forsh, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Orthopaedic Trauma Association, AO North America

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Thomas R Hunt III, MD Professor and Chairman, Joseph Barnhart Department of Orthopedic Surgery, Baylor College of Medicine

Thomas R Hunt III, MD is a member of the following medical societies: American Orthopaedic Association, American Orthopaedic Society for Sports Medicine, Southern Orthopaedic Association, AO Foundation, American Academy of Orthopaedic Surgeons, American Association for Hand Surgery, American Society for Surgery of the Hand, Mid-America Orthopaedic Association

Disclosure: Received royalty from Tornier for independent contractor; Received ownership interest from Tornier for none; Received royalty from Lippincott for independent contractor.

Chief Editor

Harris Gellman, MD Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami, Leonard M Miller School of Medicine, Clinical Professor, Surgery, Nova Southeastern School of Medicine

Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, Arkansas Medical Society

Disclosure: Nothing to disclose.

Additional Contributors

Michael S Clarke, MD Clinical Associate Professor, Department of Orthopedic Surgery, University of Missouri-Columbia School of Medicine

Michael S Clarke, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Arthroscopy Association of North America, American Academy of Pediatrics, American Association for Hand Surgery, American College of Surgeons, American Medical Association, Clinical Orthopaedic Society, Mid-Central States Orthopaedic Society, Missouri State Medical Association

Disclosure: Nothing to disclose.

Randle L Likes, DO Consulting Staff, Department of Emergency Medicine, Gateway Medical Center

Randle L Likes, DO is a member of the following medical societies: American College of Emergency Physicians, American Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

Sean D Ghidella, MD Staff Physician, Puget Sound Orthopaedics

Sean D Ghidella is a member of the following medical societies: American Association for Hand Surgery

Disclosure: Nothing to disclose.

References
  1. Souter WA. The boutonniere deformity. J Bone Joint Surg Br. 1967. 49B:710-21.

  2. Coons MS, Green SM. Boutonniere deformity. Hand Clin. 1995 Aug. 11 (3):387-402. [Medline].

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  4. Kim JP, Go JH, Hwang CH, Shin WJ. Restoration of the central slip in congenital form of boutonniere deformity: case report. J Hand Surg Am. 2014 Oct. 39 (10):1978-81. [Medline].

  5. Feldon P, Terrono AL, Nalebuff EA, Millender LH. Rheumatoid arthritis and other connective tissue diseases. Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH, eds. Green’s Operative Hand Surgery. 6th ed. Philadelphia: Elsevier; 2011. 2: 2052-6.

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  8. Tsuge K. Congenital aplasia or hypoplasia of the finger extensors. Hand. 1975 Feb. 7 (1):15-21. [Medline].

  9. Carneiro RS. Congenital attenuation of the extensor tendon central slip. J Hand Surg Am. 1993 Nov. 18 (6):1004-7. [Medline].

  10. Elson RA. Rupture of the central slip of the extensor hood of the finger. A test for early diagnosis. J Bone Joint Surg Br. 1986 Mar. 68 (2):229-31. [Medline].

  11. Boyes JH. Bunnell's Surgery of the Hand. 5th ed. Philadelphia: JB Lippincott; 1971. 393.

  12. Griffin M, Hindocha S, Jordan D, Saleh M, Khan W. Management of extensor tendon injuries. Open Orthop J. 2012. 6:36-42. [Medline].

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  14. Burton RI. Extensor tendons--late reconstruction. Green DP, ed. Operative Hand Surgery. New York: Churchill Livingstone; 1988. 2073-116.

  15. Littler JW, Eaton RG. Redistribution of forces in the correction of Boutonniere deformity. J Bone Joint Surg Am. 1967 Oct. 49 (7):1267-74. [Medline].

  16. Meadows SE, Schneider LH, Sherwyn JH. Treatment of the chronic boutonniere deformity by extensor tenotomy. Hand Clin. 1995 Aug. 11 (3):441-7. [Medline].

  17. Stern PJ. Extensor tenotomy: a technique for correction of posttraumatic distal interphalangeal joint hyperextension deformity. J Hand Surg Am. 1989 May. 14 (3):546-9. [Medline].

  18. Curtis RM, Reid RL, Provost JM. A staged technique for the repair of the traumatic boutonniere deformity. J Hand Surg Am. 1983 Mar. 8 (2):167-71. [Medline].

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Lateral view of relevant finger anatomy.
Normal lateral band location, dorsal to axis of rotation of proximal interphalangeal joint.
After central slip disruption, lateral bands migrate volar to axis of rotation of proximal interphalangeal joint.
Boutonnière deformity. Image courtesy of David Bozentka, MD, University of Pennsylvania School of Medicine, published by Medscape (Late Reconstruction of Flexor and Extensor Tendon Injuries at http://www.medscape.com/viewarticle/717388).
Radiographic evidence of boutonnière deformities. Image courtesy of Radiopaedia.org; case by Dr Aditya Shetty (http://radiopaedia.org/cases/rheumatoid-arthritis-13).
Bunnell safety-pin splint.
Boutonnière deformity.
 
 
 
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