Tendon injuries can be frustrating for your child. And left untreated, can often lead to long-term problems. Fortunately, our orthopedic team is experienced in tendon injuries, including boutonniere deformity. And, because no two kids or injuries are alike, we'll develop a plan of care that is as unique as your child.
Boutonnière deformity is the result of an injury to the tendons that straightens the middle joint of your finger. The result is that the middle joint of the injured finger will not straighten, while the fingertip bends back. Unless this injury is treated promptly, the deformity may progress, resulting in permanent deformity and impaired functioning.
Other names for this condition are:
- Buttonhole deformity
- Central slip disruption
- Central slip injury
- Deformity of finger
- Extensor tendon rupture
- Pip joint sprain
There are several tendons in your fingers that work together to bend and straighten the finger. These tendons run along the side and top of the finger. The tendon on the top of the finger attaches to the middle bone of the finger (the central slip of tendon). When this tendon is injured, the finger is not able to be fully straightened.
This problem may be caused by:
- A cut to the top of the finger
- A blow to the top of a bent middle finger with an object, such as a ball
- Weak tendons from health problems, such as rheumatoid arthritis
Rheumatoid arthritis can raise your child’s risk of developing this problem.
Signs of boutonnière deformity can develop immediately following an injury to the finger or may develop a week to 3 weeks later.
- The finger at the middle joint cannot be straightened and the fingertip cannot be bent.
- Swelling and pain occur and continue on the top of the middle joint of the finger.
The doctor will ask about your child’s symptoms and health history. A physical exam will be done, paying close attention to the finger. You may be asked how the injury happened.
In some cases, an X-ray may be done to check for a fracture.
Boutonnière deformity must be treated early to help you retain the full range of motion in the finger. Nonsurgical treatment is usually preferred, and may include:
- Splints: A splint will be applied to the finger at the middle joint to straighten it. This keeps the ends of the tendon from separating as it heals. It also allows the end joint of the finger to bend. It is important to wear the splint continuously for the recommended length of time -- usually 6 weeks for a young patient and 3 weeks for an elderly patient. Following this period of immobilization, you may still have to wear the splint at night. A commercial splint used in treating boutonnière deformity. Splinting helps keep the ends of the tendon from separating during healing.
- Exercises: Your physician may recommend stretching exercises to improve the strength and flexibility in the fingers.
- Protection: If you participate in sports, you may have to wear protective splinting or taping for several weeks after the splint is removed.
People with boutonnière deformity caused by arthritis may be treated with oral medications or corticosteroid injections, as well as splinting.
While nonsurgical treatment of boutonnière deformity is preferred, surgery is an option in certain cases, such as when:
- The deformity results from rheumatoid arthritis.
- The tendon is severed.
- A large bone fragment is displaced from its normal position.
- The condition does not improve with splinting.
Surgery can reduce pain and improve functioning, but it may not be able to fully correct the condition and make the finger look normal. If the boutonniere deformity remains untreated for more than 3 weeks, it becomes much more difficult to treat.