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Boutonniere - Observation
Test, Exam and Signs
Historical Overview
Boutonniere deformity is derived from the French word “
boutonniere
,” meaning button hole. When this occurs in a finger the head of one of the proximal phalanx pops through the opening in the extensor hood, as though bone is popping through a button hole.
Description
Boutonniere deformity is an extensor tendon injury characterized by proximal interphalangeal joint (PIP) flexion and distal interphalangeal (DIP) joint extension. As the disease progresses, the deformity becomes a permanent fixed PIP flexion contracture.
Pathophysiology
Boutonniere deformity arises from articular erosions and soft-tissue laxity.
Boutonniere deformity also arises from injuries to the extensor tendon hood at the PIP.
The injury often is a traumatic rupture or laceration of the extensor hood.
Instructions
Ask the patient to extend his/her affected finger and observe the lack of PIP joint extension.
Extend the finger passively to evaluate whether there is an extension lag or fixed contracture.
Observe patient’s range of motion, i.e. extension and flexion of PIP joint and DIP joint.
Variations
The boutonniere can be a PIP joint extension lag where the joint can be passively extended by the examiner or a fixed contracture of the joint that can not be actively or passively extended.
Related Signs and Tests
Extensor tendon exam
Intrinsic muscle testing
Presentation Photos and Related Diagrams
Boutonniere
Boutonniere
Definition of Positive Result
A positive result occurs when the patient exhibits PIP flexion with or without DIP hyperextension.
Definition of Negative Result
A negative result occurs when the patient does not exhibit PIP flexion and DIP extension and has a normal range of motion equal in both the right and left hands.
Comments and Pearls
Boutonniere deformity usually only affects one finger, but multiple affected fingers can also occur.
In patients with rheumatoid arthritis, joint involvement is often distributed symmetrically.
Congenital boutonniere deformity indicates embryonic developmental failures and is rare except in the fifth finger where the deformity is call camptodactyly.
Diagnoses Associated with Tests, Exams and Signs
BOUTONNIERE DEFORMITY
EXTENSOR TENDON LACERATION
EXTENSOR TENDON RUPTURE (VAUGHAN-JACKSON SYNDROME)
RHEUMATOID ARTHRITIS
References
Culp R, Jacoby S.
Musculoskeletal Examination of the Elbow, Wrist and Hand: Making the Complex Simple
. New Jersey: SLACK Incorporated, 2012.
Kim, Go, Hwang, et al. Restoration of the Central Slip in Congenital Form of Boutonniere Deformity: Case Report.
J Hand Surg
Am
2014;
39(10):1978-81.
PMID: 25042044
To P, Watson JT. Boutonniere Deformity.
J Hand Surg
Am
2011; 36(1): 139-42.
PMID: 21193133
Williams K, Terrono AL. Treatment of Boutonniere Finger Deformity in Rheumatoid Arthritis.
J Hand Surg
2011;36(8):1388-93.
PMID: 21741772