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  • BD

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  • 736.21 Boutonnière deformity

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  • M20.02 Boutonnière deformity
  • M20.021 Boutonnière deformity of right finger(s)
  • M20.022 Boutonnière deformity of left finger(s)
  • M20.029 Boutonnière deformity of unspecified finger(s)

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Description

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  • Generally occurs from a forceful blow to a flexed finger
  • Severed central slip tendon
  • Signs and symptoms may develop in acute to subacute phase of injury
  • Flexion of the proximal interphalangeal joint (PIP) and extension of the distal interphalangeal joint (DIP)
  • Injury to the central slip tendon

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Essentials of Diagnosis

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  • Diagnosis is usually made by clinical examination or x-ray
  • Assess finger ROM
  • Boutonniere classification
    • I: Mild extension lag, passively correctable
    • II: Moderate extension lag, passively correctable
    • III: Mild flexion contracture
    • IV: Advanced flexion contracture

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General Considerations

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  • Symptoms can occur up to a few weeks after trauma
  • Inflammation around the joint
  • Can be associated with trauma (forceful blow or cut of the tendon)
  • Rheumatoid arthritis

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Demographics

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  • Adults
    • Hit or blow onto the finger, basketball3

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Signs and Symptoms

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  • Pain with grasping
  • Flexion of the proximal interphalangeal joint (PIP) and extension of the distal interphalangeal joint (DIP)
  • Inflammation around the joint
  • Joint redness and pain

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Functional Implications

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  • Pain with grasping, holding objects
  • Inability to fully extend the finger

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Possible Contributing Causes

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  • Trauma
  • Rheumatoid arthritis
  • Central slip tendon injury
  • Joint arthritis/injury
  • Nerve damage
  • Burns
  • Infection
  • Osteoarthritis

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Differential Diagnosis

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  • Pseudo-boutonniere deformity
    • PIP joint flexion contracture with restricted flexion of the DIP
  • Gout
  • Mallet finger
  • Fracture

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Imaging

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  • Bone spur, location, and size

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Medication

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  • Anti-inflammatory
  • Corticosteroid injection

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Medical Procedures

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  • Surgery in the case of RA, severed tendon, or minimal improvement with splinting
  • Repair of the extensor tendon

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  • For Imaging, x-ray
  • For corticosteroid injection
  • For surgical consult

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  • Pain with grasping objects for work and daily activities

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  • Haines-Zancolli test
  • Thenar muscle strength test (lateral pinch dynamometry)
  • Manipulative ability test (nine-hole peg test)

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  • Rest, to reduce inflammation
  • Bracing/splinting
  • Safety pin splinting is applied for approx 4 to 6 weeks to help straighten the finger
  • Taping techniques
  • Address swelling and pain
  • Address pain
  • Address weakness and joint instability
    • Strengthening of extensors
  • Address lack of flexibility
  • Address joint mobilization
    • DIP glides & rotation
  • Address soft tissue mobilization

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  • Patient will be able to grasp and hold a shovel for gardening

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  • Good if early treatment; focus on stretching ...

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