Boutonniere deformity

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Boutonniere deformity
Classification and external resources
Human hand bones (Joints visible but not labeled.)
ICD-10	M20.0
ICD-9	736.21
eMedicine	orthoped/24

Boutonniere deformity is a deformed position of the fingers or toes, in which the joint nearest the knuckle (PIP) is permanently bent toward the palm while the farthest joint (DIP) is bent back away (PIP flexion with DIP hyperextension). It is commonly caused by injury^[1] or by an inflammatory condition like rheumatoid arthritis, or genetic conditions like Ehlers Danlos Syndrome.

Stages

Mild extension lag, passively correctable
Moderate extension lag, passively correctable
Mild flexion contracture
Advanced flexion contracture

Higher numbers indicate a more severe problem and greater likelihood of a poor final outcome.

Pathophysiology

Boutonniere deformity in a patient with Rheumatoid Arthritis

This flexion deformity of the proximal interphalangeal joint is due to interruption of the central slip of the extensor tendon such that the lateral slips separate and the head of the proximal phalanx pops through the gap like a finger through a button hole (thus the name, from French boutonnière "button hole"). The distal joint is subsequently drawn into hyperextension because the two peripheral slips of the extensor tendon are stretched by the head of the proximal phalanx (note that the two peripheral slips are inserted into the distal phalanx, while the proximal slip is inserted into the middle phalanx). This deformity makes it difficult or impossible to extend the proximal interphalangeal joint.

References

↑ http://orthoinfo.aaos.org/topic.cfm?topic=A00004&return_link=0

"Boutonniére Deformity". Your Orthopaedic Connection. American Academy of Orthopaedic Surgeons.

External links

Musculoskeletal disorders: Acquired musculoskeletal deformities (M20–M25, M95, 734–738)

Upper limb

shoulder (Winged scapula, Adhesive capsulitis, Rotator cuff tear, Subacromial bursitis)

elbow (Cubitus valgus, Cubitus varus)

hand deformity (Wrist drop, Boutonniere deformity, Swan neck deformity)

Lower limb

hip (Protrusio acetabuli, Coxa valga, Coxa vara)

leg (Unequal leg length)

patella (Luxating patella, Chondromalacia patellae, Patella baja, Patella alta)

foot deformity (Bunion/hallux valgus, Hallux varus, Hallux rigidus, Hammer toe, Foot drop, Flat feet, Club foot)

Genu recurvatum

Head

Cauliflower ear

General terms

M: JNT

anat (h/c, u, t, l)/phys

noco (arth/defr/back/soft)/cong, sysi/epon, injr

proc, drug (M01C, M4)

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