Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ BD ++ 736.21 Boutonnière deformity ++ M20.02 Boutonnière deformityM20.021 Boutonnière deformity of right finger(s)M20.022 Boutonnière deformity of left finger(s)M20.029 Boutonnière deformity of unspecified finger(s) ++ 4E: Impaired joint mobility, motor function, muscle performance, and ROM associated with localized inflammation1 +++ Description ++ Generally occurs from a forceful blow to a flexed fingerSevered central slip tendonSigns and symptoms may develop in acute to subacute phase of injuryFlexion of the proximal interphalangeal joint (PIP) and extension of the distal interphalangeal joint (DIP)Injury to the central slip tendon +++ Essentials of Diagnosis ++ Diagnosis is usually made by clinical examination or x-rayAssess finger ROMBoutonniere classificationI: Mild extension lag, passively correctableII: Moderate extension lag, passively correctableIII: Mild flexion contractureIV: Advanced flexion contracture +++ General Considerations ++ Symptoms can occur up to a few weeks after traumaInflammation around the jointCan be associated with trauma (forceful blow or cut of the tendon)Rheumatoid arthritis +++ Demographics ++ AdultsHit or blow onto the finger, basketball3 +++ Signs and Symptoms ++ Pain with graspingFlexion of the proximal interphalangeal joint (PIP) and extension of the distal interphalangeal joint (DIP)Inflammation around the jointJoint redness and pain +++ Functional Implications ++ Pain with grasping, holding objectsInability to fully extend the finger +++ Possible Contributing Causes ++ TraumaRheumatoid arthritisCentral slip tendon injuryJoint arthritis/injuryNerve damageBurnsInfectionOsteoarthritis +++ Differential Diagnosis ++ Pseudo-boutonniere deformityPIP joint flexion contracture with restricted flexion of the DIPGoutMallet fingerFracture +++ Imaging ++ X-ray ++ Bone spur, location, and size +++ Medication ++ Anti-inflammatoryCorticosteroid injection +++ Medical Procedures ++ Surgery in the case of RA, severed tendon, or minimal improvement with splintingRepair of the extensor tendon ++ For Imaging, x-rayFor corticosteroid injectionFor surgical consult ++ Pain with grasping objects for work and daily activities ++ Haines-Zancolli testThenar muscle strength test (lateral pinch dynamometry)Manipulative ability test (nine-hole peg test) ++ Rest, to reduce inflammationBracing/splintingSafety pin splinting is applied for approx 4 to 6 weeks to help straighten the fingerTaping techniquesAddress swelling and painIceAddress painIceMassageJoint mobilizationElectric stimulationInfraredAddress weakness and joint instabilityStrengthening of extensorsAddress lack of flexibilityStretchingIntrinsic flexor stretchingFluidotherapyAddress joint mobilizationDIP glides & rotationAddress soft tissue mobilization ++ Patient will be able to grasp and hold a shovel for ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.