Boutonnière deformity (BD) prevents you from straightening your finger. The disorder affects the finger’s system of tendons. The tendons allow you to flex and straighten your finger.
Tendons in Finger
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In BD, the tendon on the top of the finger (called the central slip) is torn or cut from the other tendons. This creates a tear that resembles a buttonhole (or
in French). The first finger joint is forced down and the fingertip bends back at the second joint. The tendons on this part of the finger are flat and thin. They are prone to injury. If you have BD in the thumb, it affects a joint called the metacarpophalangeal (MCP).
BD can be caused by:
A powerful blow to the fingerA cut to the finger’s central slipAn injury to the first finger joint—called the proximal interphalangeal (PIP) jointA severe burn on the hand
Factors that may increase your risk of developing BD include:
Dupuytren’s contractureParticipating in contact sports, especially those involving catching and throwing balls such as football and basketball
Symptoms may include:
Pain and swelling on the top of the finger’s middle joint—the PIP jointInability to straighten the finger at the middle joint
Sign of injury (such as
dislocation) to the PIP joint
Sign of injury (such as fracture or dislocation) to the MCP joint if the thumb is involved
You will be asked about your symptoms and medical history. A physical exam will be done, paying close attention to:
Muscle strengthJoint damageRange of motionPresence of swellingEvidence of infectionTenderness in the finger
may be done to see if you have a fracture.
Talk with your doctor about the best treatment plan for you. Treatment options include the following:
Your doctor may recommend the following medications:
Corticosteroids—to reduce inflammationNonsteroidal anti-inflammatory drugs (NSAIDs)—to reduce pain and inflammation
For milder cases, the treatment is nonsurgical and may involve:
Applied to the middle joint to fully extend itUsed for 3-6 weeksStretching and strengthening exercises
massage, ultrasound therapy, electrical stimulation
If your finger does not improve, you may need surgery.
Surgery is needed in severe cases. For example, when the tendon is cut or when the deformity has lasted a long time. Surgery generally does not return your finger to the way it was working before the injury. But, you may have some improvement. After surgery, you will have to do exercises to strengthen the finger.
To help reduce your chance of getting BD:
Wear the proper equipment when playing sports.If you have rheumatoid arthritis, ask you doctor about ways to protect your joints.
Boutonniere deformity of the finger. Orthogate website. Available at:
http://www.orthogate.org/patient-education/hand/boutonniere-deformity-of-the-finger.html. Updated July 27, 2006. Accessed August 10, 2015.
To P, Watson JT. Boutonniere deformity.
J Hand Surg Am. 2011 Jan; 36(1):139-42.
Last reviewed September 2016 by Teresa Briedwell, PT, DPT, OCS, CSCS
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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