Boutonniere deformity occurs when the central joint of a finger (or, less usually, a toe) becomes locked in a bent position and cannot straighten, while the joint toward the tip of the finger or toe bends upwards. It is often caused by an injury to the central slip tendon, which is responsible for straightening the finger at the middle joint. This injury can produce a rip in the tendon, resulting in deformity, as well as arthritis, which weakens or displaces the tendon.
- Evaluation and Diagnosis: To confirm damage to the central slip tendon, a clinical examination is conducted, frequently with X-rays and Elson's test.
- Initial Management: In mild or recent cases, a splint is used to keep the PIP joint extended for 6–8 weeks to allow for tendon recovery.
- Physical Therapy: To strengthen and regain finger mobility following splinting, systematic physiotherapy is started.
- Surgical Intervention: If non-surgical treatment is unsuccessful or in severe/chronic situations, surgical repair or rebuilding of the tendon, occasionally involving joint fusion, is carried out.
- Post-Treatment Rehabilitation: Hand therapy starts a week after surgery, while the finger is splinted to promote functional recovery and avoid stiffness.
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