Boutonniere deformity: Difference between revisions

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**Disruption of central tendon causes lateral bands to be displaced volarly, causing them to act like flexors
**Disruption of central tendon causes lateral bands to be displaced volarly, causing them to act like flexors
*FDP still intact
*FDP still intact
[[File:Boutonniere deformity.jpg|thumb]]


==Clinical Features==
==Clinical Features==
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*Jamming
*Jamming
*Laceration distal to PIP can injure central tendon
*Laceration distal to PIP can injure central tendon
*On exam, will see hyperflexion of PIP w/ hyperextension of DIP and MP joints.
*On exam, will see hyperflexion of PIP with hyperextension of DIP and MP joints.


==Differential Diagnosis==
==Differential Diagnosis==
*Rheumatoid Arthritis
*[[Rheumatoid arthritis]]
*Volar PIP dislocation
*Volar [[Proximal interphalangeal dislocation (finger)|PIP dislocation]]
*Flexion contracture of PIP joint
*Flexion contracture of PIP joint


==Diagnosis==
{{Hand and finger injury DDX}}


==Evaluation==
*Elson’s test: bend PIP 90 deg over edge of table, extend middle phalanx against resistance. Should have weak PIP extension and DIP goes rigid as lateral bands have to work.  
*Elson’s test: bend PIP 90 deg over edge of table, extend middle phalanx against resistance. Should have weak PIP extension and DIP goes rigid as lateral bands have to work.  
**Positive test indicated rupture of central tnedon slip.  
**Positive test indicated rupture of central tendon slip.
*XR to assess for avulsion [[phalynx fracture|fracture of middle phalanx]]


==Management==
==Management==
*XR to assess for avulsion fracture of middle phalanx
*If open or with displaced avulsion fracture: operative repair
*If open or with displaced avulsion fracture: operative repair
*Closed: splint in extension (Both DIP and PIP) for up to 6 weeks, refer to hand surgeon. NO flexion of DP permitted for duration of splinting, including during cleaning. Repair extensor tendon if injured.  
*Closed: splint in extension (Both DIP and PIP) for up to 6 weeks, refer to hand surgeon. NO flexion of DP permitted for duration of splinting, including during cleaning. Repair extensor tendon if injured.
 
==Disposition==
==Disposition==
*Hand specialist follow up if closed injury
*Hand specialist follow up if closed injury
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==See Also==
==See Also==
*[[Hand_and_finger_diagnoses]]
*[[Hand and finger diagnoses]]
*[[Jammed_finger]]
*[[Hand_Tendon_Injuries]]


==External Links==
==External Links==


==References==
==References==
*Tintinalli
*Rosen's
<references/>
<references/>


[[Category:Orthopedics]]
[[Category:Orthopedics]]
[[Category:Sports Medicine]]

Latest revision as of 16:14, 18 October 2019

Background

  • Extensor Zone III Injury over the PIP joint.
  • Most commonly central tendon is injured, causing FDS to be unopposed, thus causing flexion of PIP
    • Disruption of central tendon causes lateral bands to be displaced volarly, causing them to act like flexors
  • FDP still intact
Boutonniere deformity.jpg

Clinical Features

  • History of trauma to digit and painful PIP.
  • Forced flexion of actively extended finger
  • Direct blow to PIP
  • Jamming
  • Laceration distal to PIP can injure central tendon
  • On exam, will see hyperflexion of PIP with hyperextension of DIP and MP joints.

Differential Diagnosis

Hand and finger injuries

Evaluation

  • Elson’s test: bend PIP 90 deg over edge of table, extend middle phalanx against resistance. Should have weak PIP extension and DIP goes rigid as lateral bands have to work.
    • Positive test indicated rupture of central tendon slip.
  • XR to assess for avulsion fracture of middle phalanx

Management

  • If open or with displaced avulsion fracture: operative repair
  • Closed: splint in extension (Both DIP and PIP) for up to 6 weeks, refer to hand surgeon. NO flexion of DP permitted for duration of splinting, including during cleaning. Repair extensor tendon if injured.

Disposition

  • Hand specialist follow up if closed injury
  • Immediate consult if deformity is caused by open injury

See Also

External Links

References