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The Bone & Joint Center
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Boutonniere Deformity - Finger Deformity

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  • Introduction
  • Anatomy
  • Causes
  • Symptoms
  • Diagnosis
  • Treatment
  • Surgery
  • Recovery
  • Prevention

Introduction

A boutonniere deformity occurs when the tendon that straightens the middle joint of your finger is injured, weakened or stretched.  The injury allows the middle finger joint to bend (flex) and the end finger joint to pull back and hyperextend.  This makes the finger appear crooked. 

A boutonniere deformity can cause pain and loss of function.  Treatments include splinting, hand therapy, and surgery.  When treated promptly, conditions tend to have the best outcomes.

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Anatomy

Your fingers are made up of three bones called phalanges.  Two joints separate the phalanges.  The distal interphalangeal (DIP) joints are located near your fingertips.  The proximal interphalangeal (PIP) joints are located in the middle of your fingers.  The extensor tendons allow your fingers to extend and straighten.  
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Causes

A boutonniere deformity occurs when the extensor tendon attachment at the central slip on the middle phalanx is injured.  The PIP joint is not able to straighten and remains bent (flexed).  The DIP joint is pulled back into hyperextension by the extensor mechanism that has become out of balance.  This results in a crooked and poorly functioning finger. 
 
Arthritis, burns, Dupuytren’s contracture, and injuries, can disrupt the extensor tendon.  The tendon may partially or completely tear.  The extensor tendon can remain intact but pull a piece of bone away from where it attaches on the phalanx, also called an avulsion fracture.
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Symptoms

A boutonniere deformity can cause your PIP joint to feel painful and swollen.  You may not be able to straighten out your PIP joint.  Your DIP joint may be hyperextended, causing your finger to look crooked.
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Diagnosis

Your doctor can diagnose a boutonniere deformity by examining your hand.  X-rays will be taken to check for  fractures and the condition of the joints. 
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Treatment

Some boutonniere deformities can be treated with splinting.  Splinting can help certain new and old injuries.  There are many types of splints for boutonniere deformities.  Hand therapy is especially important to ease symptoms and gain functioning.  Splinting is usually tried for at least six weeks.
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Surgery

Surgery may be necessary to reconstruct a tendon or joint.  If past treatments and surgery fail, the bones in the finger can be surgically fused together and kept from moving.  All types of surgeries are followed by splinting and hand therapy.
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Recovery

Recovery from boutonniere deformity surgery can take three to four months.  It can take up to six months for a full recovery.  Recovery is individualized and your doctor will let you know what to expect.
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Prevention

You should contact your doctor if you notice you are developing a boutonniere deformity.  In most cases, early treatment is associated with the best outcomes.  Following treatment, your hand therapist can recommend ways to perform your regular activities to help you avoid future injuries. 
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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on February 16, 2022. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.

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At The Bone & Joint Center, our compassionate orthopedic specialists provide a wide range of services including orthopedic surgery, shoulder replacement, hand surgery, shoulder scope, hip replacement, knee replacement, joint revision, minimally invasive procedures, ligament reconstruction, physical therapy, and occupational therapy.

  • Home
  • About Us
    • Careers
    • Back
  • Meet the Providers
    • Bone & Joint Physicians
      • Duncan B. Ackerman, MD
      • Timothy J. Bopp, MD
      • Chad B. Carlson, MD
      • Joseph W. Carlson, MD
      • Derrick O. Cote, MD
      • Brian P. Dahl, MD
      • Timothy J. Juelson, MD
      • Steven Kraljic, MD
      • Brock A. Norrie, MD
      • Troy D. Pierce, MD
      • Back
    • Advanced Practice Providers
    • Therapists
    • Back
  • Specialties
    • Foot & Ankle
    • General Orthopedics
    • Hand & Wrist
    • Hip & Knee
    • Joint Replacement
    • Neurosurgery
    • Osteoporosis
    • Pediatric Orthopedics
    • Shoulder & Elbow
    • Sports Injuries
    • Trauma & Fractures
    • Back
  • Procedures & Services
    • Orthopedic Surgery
    • Shoulder Replacement
    • Hand Surgery
    • Rotator Cuff – Shoulder Scope
    • Hip Replacement
    • Knee Replacement
    • Joint Revision
    • Minimally Invasive Procedures
    • Ligament Reconstruction
    • Physical Therapy
    • Occupational Therapy
    • Hand Therapy
    • Back
  • Patient Resources
    • For New Patients
    • Therapy Protocols
    • Schedule an Appointment
    • Patient Portal
    • Medical Records Release
    • Patient Education
    • Important Phone Numbers
    • Other Resources
    • Good Faith Estimate Notice
    • Notice of Privacy Policy
    • Back
  • Blog
  • Contact & Locations
    • Beulah, ND
    • Bismarck, ND
    • Dickinson, ND
    • Garrison, ND
    • Hazen, ND
    • Hettinger, ND
    • Linton, ND
    • Minot, ND
    • Turtle Lake, ND
    • Williston, ND
    • Wishek, ND
    • Back
  • Ortho Update 2025
    • Achilles Tendon Repair Rehabilitation
    • Achilles Tendon Ruptures
    • ACL Tears: Repair or Reconstructions?
    • ACL Rehab R Malm
    • Articular Cartilage Management
    • Changes over 40 years
    • Conservative Management of Low Back Pain
    • Conservative Treatment for Patella-Femoral Pain
    • Functional Core Stability
    • Imaging of the Spine for Physical Therapists
    • Interventional Pain Medicine
    • Isokinetics: What Can We Learn From the Test?
    • Managing Scapular Dyskinesia
    • Patellofemoral Management
    • Plyometrics
    • Post-op Managment of Slap Repair
    • Rehab Post Rotator Cuff Surgery
    • Remplissage and Latarjet Rehabilitation
    • Return to Sport, What’s New?
    • Robotic Shoulder Replacement
    • Rotator Cuff Disease
    • Shoulder Arthroplasty
    • Shoulder Instability with Bone Loss
    • Slap Tears
    • Spinal Stenosis
    • Total Joint Post op restrictions
    • Total Joint Replacements: Younger Patients
    • Total Knee Replacement Rehabilitation
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