Boutonniere Deformity Hand Therapy
A boutonniere deformity is an injury to the middle joint of the finger (medically called the proximal interphalangeal joint; or shortened to PIP joint), and what happens is that you’d find it impossible to straighten that particular finger joint.
To counteract that force, the end joint of the finger, the distal interphalangeal joint (shortened to DIPJ), will then hyperextend and have difficulty bending). This specific deformity and injury is caused by an injury to the extensor tendon over the top of the finger, which is known as the central slip.
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What causes a boutonniere deformity?
It can be caused by:
- tear in the central slip can occur from a dislocation of the PIP joint
- cut to the extensor tendon
- damage from inflammatory disease such as arthritis
What may appear to be simply a “jammed finger” may actually be a more serious tendon injury which may result in a boutonniere deformity. If left untreated, these injuries can result in permanent stiffness to the injured joint.
Symptoms of boutonniere deformity
The most common is difficulty to straighten the middle joint of the finger by itself; and difficulty bending the end finger joint. Patients may also experience swelling and discomfort. If a boutonniere finger goes untreated for a long period of time, the finger may become stiff, making it difficult to straighten the finger at all.
People with a boutonniere deformity will be unable to straighten their finger and will have difficulties with everyday activities, such as
- writing
- picking up coins or keeping those coins in their hands/palm
- using keys or keyboards
- washing face properly
- buttoning their clothes
- putting their hand in a pocket to take their wallet or phones
- etc
Boutonniere injury / deformity treatment
It typically starts with an assessment and diagnosis by a medical doctor. Sometimes, patients go to a hand therapist (or hand physiotherapist) direct but we’d typically send to an orthopedic surgeon or orthopedist to see if surgical treatment may help.
Boutonniere deformities that are caused by injury, arthritis or a laceration to the central slip of the extensor tendon may require corrective finger surgery.
For cases that dont require surgery (such as central slip injury but that will recover in time), the doctor will refer the patient to hand therapy. For those that need surgery, they will still require hand therapy after surgery.
Hand therapy
If the boutonniere injury or deformity doesn’t require surgical correction (the orthopedic surgeon will decide that), then the patient may be referred to hand therapy for a customized corrective orthosis splint that aims to position the injured finger in the best healing position for optimal healing.
And the patient MUST use the orthosis as instructed to get an optimal outcome for their injured finger.
Once it’s ready for mobilization and strengthening, then that’d begin the gradual therapy process until your finger gets full or as close to full recovery as possible.
Where To Next?
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