Boutonniere deformity is a deformed position of the fingers or toes, in which the joint nearest the knuckle is permanently bent toward the palm while the farthest joint is bent back away. It is commonly caused by injury or by an inflammatory condition like rheumatoid arthritis, or genetic conditions like Ehlers Danlos Syndrome. Stages Mild extension lag, passively correctable Moderate extension lag, passively correctable Mild flexion contracture Advanced flexion contracture Higher numbers indicate a more severe problem and greater likelihood of a poor final outcome.
Pathophysiology This flexion deformity of the proximal interphalangeal joint is due to interruption of the central slip of the extensor tendon such that the lateral slips separate and the head of the proximal phalanx pops through the gap like a finger through a button hole. The distal joint is subsequently drawn into hyperextension because the two peripheral slips of the extensor tendon are stretched by the head of the proximal phalanx. This deformity makes it difficult or impossible to extend the proximal interphalangeal joint. References "Boutonniére Deformity". Your Orthopaedic Connection. American Academy of Orthopaedic Surgeons. External links tonniere_deformity_of_the_thumb_mp_joint at the Duke University Health System's Orthopedics program cine.ucsd.eduupper-hand-boutonniere.html sfPhoto2sec04ch34sec04-ch034-ch034b.html Boutonniere Deformity at eMedicine MRI sequence of disruption of the extensor tendon slip.
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