Boutonniere Deformity

Abstract

Boutonniere disease is a deformity of the hand caused by disruption of the central slip as it inserts into the base of the middle phalanx. This disruption causes the PIP joint to be flexed and DIP to be hyperextended. The diagnosis can be made mostly by physical exam findings such as swelling and pain over the dorsum of the PIP joint with weakness or inability to extend the finger at that joint. There are also the “Elson” and “Stark sign” which both demonstrate DIP stiffness with the PIP in either fixed flexion or extension, respectively. Most of these injuries can be treated conservatively with NSAIDs, ice, and splinting or serial casting of the PIP in extension along with therapy to help maintain range of motion of the joints once the patient’s symptoms improve. If conservative treatment fails or if there is evidence of an open wound or fracture with displacement or angulation, surgical intervention is recommended.