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Boutonniere Deformity (BD) is a condition characterized by a deformity in the finger with the middle joint bent downwards and the distal end pointed backwards. The finger joints are connected by tendons and ligaments which allow motion. Due to tearing of the ligaments in this condition, finger bends downwards (flexed) at the proximal interphalangeal joint (PIP) and hyperextended (bent backwards) at the distal interphalangeal joint (DIP).
- Rheumatoid Arthritis– In this case, the inflammatory cells are released into the synovium (joint lining) which result in the formation of the abnormal pannus tissue. This in turn secretes substances which can damage tendons, bones and ligaments causing deformities.
- Trauma or injury– The tendon that is attached to the middle joint of the finger gets damaged if a bent finger is jammed or hit by an external force. This prevents the straightening of the joint
- Bruise or cut– A cut at the top of the finger can tear the underlying tendon causing deformity
- Dislocations and fractures: Dislocations and fractures in the bones of the hand may also lead to this condition.
- Swelling and tenderness
- Visibly deformed finger
- Limited ability to stretch the finger
- Imaging Tests: X-ray imaging helps to diagnose broken bones and soft tissue structures.
- Elson’s Test: The patient is asked to straighten the injured finger to check for loss of motion.
- Ice packs and heat therapy: Ice packs can be applied for 24-48 hours at regular intervals. They help to relieve pain and swelling. Heat therapy can also be beneficial in relieving the symptoms.
- Medications– Corticosteroids and anti-inflammatory medicines may be prescribed if the patient is suffering from Arthritis.
- Splinting– The middle part of the finger is secured using a splint for 4-6 weeks to allow the ends of the tendon to regrow and join each other. The patient may be asked to continue wearing the splint at night after 6 weeks
- Exercises– The doctor may recommend specific stretching and strengthening exercises to improve functionality. It may help to restore the normal range of motion.
- Taping: Taping is recommended if the patient is likely to participate in sports even after the treatment as a precautionary measure. It can help to provide stability to the fingers.
- Surgical treatment– This is required if the patient is suffering from Rheumatoid Arthritis, the tendon is completely torn or a piece of bone gets detached along with the tendon. The tendon and the bone are put back into their correct anatomical position.