• Boutonnière Deformity of Finger

    (BD; Buttonhole Deformity; Central Slip Disruption; Central Slip Injury; Deformity of Finger, Boutonnière; Extensor Tendon Rupture; PIP Joint Sprain)


    Boutonnière deformity (BD) prevents you from straightening your finger. The disorder affects the finger’s system of tendons. The tendons allow you to flex and straighten your finger.
    Tendons in Finger
    Finger Tendon
    Copyright © Nucleus Medical Media, Inc.


    In BD, the tendon on the top of the finger (called the central slip) is torn or cut from the other tendons. This creates a tear that resembles a buttonhole (or boutonnière in French). The first finger joint is forced down and the fingertip bends back at the second joint. The tendons on this part of the finger are flat and thin. They are prone to injury. If you have BD in the thumb, it affects a joint called the metacarpophalangeal (MCP).
    BD can be caused by:
    • A powerful blow to the finger
    • A cut to the finger’s central slip
    • An injury to the first finger joint—called the proximal interphalangeal (PIP) joint
    • A severe burn on the hand

    Risk Factors

    Factors that may increase your risk of developing BD include:


    Symptoms may include:
    • Pain and swelling on the top of the finger’s middle joint—the PIP joint
    • Inability to straighten the finger at the middle joint
    • Sign of injury (such as fracture or dislocation) to the PIP joint
    • Sign of injury (such as fracture or dislocation) to the MCP joint if the thumb is involved


    You will be asked about your symptoms and medical history. A physical exam will be done, paying close attention to:
    • Muscle strength
    • Joint damage
    • Range of motion
    • Presence of swelling
    • Evidence of infection
    • Tenderness in the finger
    An x-ray may be done to see if you have a fracture.


    Talk with your doctor about the best treatment plan for you. Treatment options include the following:


    Your doctor may recommend the following medications:
    • Corticosteroids—to reduce inflammation
    • Nonsteroidal anti-inflammatory drugs (NSAIDs)—to reduce pain and inflammation

    Nonsurgical Approaches

    For milder cases, the treatment is nonsurgical and may involve:
      • Applied to the middle joint to fully extend it
      • Used for 3-6 weeks
    • Stretching and strengthening exercises
    • Other techniques: massage, ultrasound therapy, electrical stimulation
    If your finger does not improve, you may need surgery.


    Surgery is needed in severe cases. For example, when the tendon is cut or when the deformity has lasted a long time. Surgery generally does not return your finger to the way it was working before the injury. But, you may have some improvement. After surgery, you will have to do exercises to strengthen the finger.


    To help reduce your chance of getting BD:
    • Wear the proper equipment when playing sports.
    • If you have rheumatoid arthritis, ask you doctor about ways to protect your joints.


    National Institutes of Arthritis and Musculoskeletal and Skin Diseases http://www.niams.nih.gov

    Ortho Info—American Academy of Orthopaedic Surgeons http://orthoinfo.aaos.org


    Canadian Orthopaedic Foundation http://www.canorth.org

    Canadian Physiotherapy Association http://www.physiotherapy.ca


    Boutonniere deformity of the finger. Orthogate website. Available at: http://www.orthogate.org/patient-education/hand/boutonniere-deformity-of-the-finger.html. Updated July 27, 2006. Accessed August 10, 2015.

    Dupuytren disease. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114104/Dupuytren-disease. Updated April 19, 2016. Accessed September 29, 2016.

    To P, Watson JT. Boutonniere deformity. J Hand Surg Am. 2011 Jan; 36(1):139-42.

    Revision Information

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