Boutonniere Deformity Workup

  • Author: Randle L Likes, DO; Chief Editor: Harris Gellman, MD   more...
 
Updated: Apr 18, 2010
 

Laboratory Studies

Laboratory studies may be helpful if infection or inflammatory arthritis is suspected.

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Imaging Studies

Standard radiographs of the hand and digit, including posteroanterior, oblique, and lateral views, usually suffice. If no bony abnormalities are found with initial radiographs and a high clinical suspicion of fracture or joint disfigurement exists, the following may be obtained:

  • Flexion and extension views
  • Stress views
  • Fluoroscopic examination
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Other Tests

Two specific tests can aid in the early recognition of acute injuries to the central slip and extensor mechanism, as follows:

  • A 15-20° or greater loss of active extension of the PIP joint, with the wrist and MP fully flexed
  • Extravasation of intra-articular radiopaque dye dorsal and distal to the PIP joint

The Haines-Zancolli test may aid in the decision to treat with splinting or surgery.

  • The test result is considered negative if passive flexion of the DIP is still possible with the PIP maintained in extension.
  • The test result is positive if flexion of the DIP is not possible with PIP in extension.
  • Less chance of successful conservative treatment exists with a positive Haines-Zancolli test result.
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Contributor Information and Disclosures
Author

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 and American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Sean D Ghidella, MD  Chief of Orthopedic Service, Consulting Surgeon, Department of Orthopedic Surgery, Madigan Army Medical Center

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

Disclosure: Nothing to disclose.

Specialty Editor Board

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, American Academy of Pediatrics, American Association for Hand Surgery, American College of Surgeons, American Medical Association, Arthroscopy Association of North America, Clinical Orthopaedic Society, Mid-Central States Orthopaedic Society, and Missouri State Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Thomas R Hunt III, MD  John D Sherrill Professor and Director of Orthopaedic Surgery, Surgeon in Chief of UAB Highlands Hospital, Director of Hand and Upper Extremity Fellowship, University of Alabama at Birmingham

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

Disclosure: Tornier Consulting fee Review panel membership; Tornier Royalty None; Tornier Ownership interest None

Dinesh Patel, MD, FACS  Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital

Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

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 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, and Arkansas Medical Society

Disclosure: Nothing to disclose.

References

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  20. Slesarenko YA, Hurst LC, Mai K. Suture anchor technique for anatomic reconstruction in chronic boutonnière deformity. Tech Hand Up Extrem Surg. Sep 2005;9(3):172-4. [Medline].

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

 
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Boutonnière deformity.
Normal lateral band location, dorsal to the axis of rotation of the proximal interphalangeal joint.
After central slip disruption, lateral bands migrate volar to the axis of rotation of the proximal interphalangeal joint.
Lateral view of relevant finger anatomy.
Bunnell safety-pin splint.
 
 
 
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