Boutonnière Deformity

Boutonnière deformity is a condition affecting the finger, where the middle joint bends downwards and the fingertip bends upwards.

This occurs when the tendon that straightens the middle joint of the finger is damaged or disrupted. As a result, the normal balance of the finger is altered, leading to the characteristic shape.

The condition may develop following an injury, such as a force to a bent finger, or as a result of inflammatory conditions affecting the joints.

If not treated early, the deformity can become fixed and more difficult to correct.

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Diagnosis is based on clinical assessment, including examination of finger movement and alignment.

Assessment focuses on identifying the underlying tendon injury and the stage of the deformity.

Imaging may be used in selected cases.

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Treatment depends on the severity and timing of the condition.

Non-surgical treatment may include:

• Splinting to hold the middle joint in a straight position
• Hand therapy to maintain movement and function

Splinting must usually be worn continuously for several weeks.

Surgical treatment may be considered in more advanced or long-standing cases. This may involve:

• Repair of the tendon
• Reconstruction procedures
• Joint procedures if the deformity is fixed

The aim is to restore finger alignment and function.

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Surgical treatment depends on the severity and timing of the condition.

Procedures may involve repair or reconstruction of the tendon, or correction of joint position in more advanced cases.

The aim is to restore alignment and improve function.

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Recovery depends on the type of treatment performed.

Recovery typically includes:

• Continuous splinting for a period of time
• Hand therapy to maintain and restore movement
• Gradual return to normal activities

Early adherence to treatment is important for a good outcome.

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As with any surgical procedure, there are potential risks, although these are uncommon.

Possible complications include:

• Infection (around 1%), usually treated with antibiotics
• Swelling or stiffness, which may take time to settle
• Scar sensitivity
• Nerve irritation or injury (rare)
• Ongoing pain or discomfort, which typically improves over time
• Recurrence of deformity
• Residual stiffness or reduced movement

Very rarely, a condition known as complex regional pain syndrome (CRPS) can occur, leading to prolonged pain and sensitivity.

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You should seek medical advice if you notice difficulty straightening your finger or a change in its shape, particularly following an injury.

Early assessment is important, as treatment is more effective in the early stages

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