Boutonnière Deformity

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.

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.

Boutonnière and Swan-Neck Deformity

Boutonnière Deformity in Rheumatoid Arthritis

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There are multiple boutonnière deformities of the fingers and thumbs in this patient with advanced rheumatoid arthritis. Boutonnière deformity is characterized by flexion at the proximal interphalangeal joint and hyperextension at the distal interphalangeal joint. There also are multiple rheumatoid nodules over the knuckles and interphalangeal joints.

By permission of the publisher. From Matteson E, Mason T: Atlas of Rheumatology. Edited by G Hunder. Philadelphia, Current Medicine, 2005.