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Merck Manual
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Professional /
Musculoskeletal and Connective Tissue Disorders /
Hand Disorders /
... /
Boutonnière Deformity /

OTHER TOPICS IN THIS CHAPTER

Hand Disorders

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Primary Malignant Bone Tumors
A 44-year-old man comes to the office because he has had pain and swelling in his right upper arm for the past month. There is no history of trauma to the arm. On physical examination, there is tenderness to palpation of the arm and a mass is noted. X-ray studies show a fracture of the humerus, mottled appearance of bone, and a large, isolated soft-tissue mass in the upper arm. Based on these findings, which of the following is the most likely suspected diagnosis?  

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Boutonnière Deformity

(Buttonhole Deformity)

By

David R. Steinberg

, MD, Perelman School of Medicine at the University of Pennsylvania

Last full review/revision May 2020| Content last modified May 2020
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Topic Resources

A boutonnière deformity consists of flexion of the proximal interphalangeal (PIP) joint accompanied by hyperextension of the distal interphalangeal (DIP) joint.

(See also Overview and Evaluation of Hand Disorders.)

Boutonnière deformity can result from tendon laceration, dislocation, fracture, osteoarthritis, or rheumatoid arthritis. Classically, the deformity is caused by disruption of the central slip attachment of the extensor tendon to the base of the middle phalanx, allowing the proximal phalanx to protrude (“buttonhole”) between the lateral bands of the extensor tendon.

Boutonnière and Swan-Neck Deformity

Boutonnière and Swan-Neck Deformity

Initial treatment of boutonnière deformity consists of splinting, but it must occur before scarring and fixed deformities develop. Surgical reconstruction often cannot restore normal motion but may decrease the deformity and improve hand function.

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Overview and Evaluation of Hand Disorders
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