Boutonnière Deformity of Finger
(BD; Buttonhole Deformity; Central Slip Disruption; Central Slip Injury; Deformity of Finger, Boutonnière; Extensor Tendon Rupture; PIP Joint Sprain)
Pronounced: boo-ten-EER de-FORM-uh-tee of finger
by Mary Cresse
Boutonnière deformity (BD) prevents straightening of the finger. The disorder affects the finger’s system of tendons. The tendons allow a person to flex and straighten his or her finger.
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 boutonnière 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. BD in the thumb affects a joint called the metacarpophalangeal (MCP).
BD can be caused by:
Factors that may increase the risk of developing BD include:
Symptoms may include:
You will be asked about your symptoms and medical history. A physical exam will be done, paying close attention to:
An x-ray may be done to see if you have a fracture.
Treatment options include the following:
The following medications may be advised:
For milder cases, the treatment is nonsurgical and may involve:
If the finger does not improve, surgery may be needed.
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 the finger to the way it was working before the injury. But, there may be some improvement. After surgery, exercises can help to strengthen the finger.
To help reduce your chance of getting BD:
National Institutes of Arthritis and Musculoskeletal and Skin Diseases
Ortho Info—American Academy of Orthopaedic Surgeons
Canadian Orthopaedic Foundation
Canadian Physiotherapy Association
Boutonniere deformity of the finger. Orthogate website. Available at:
...(Click grey area to select URL)
Published July 20, 2006. Accessed September 7, 2017.
Dupuytren disease. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114104/Dupuytren-disease . Updated February 9, 2017. Accessed September 7, 2017.
To P, Watson JT. Boutonniere deformity. J Hand Surg Am. 2011 Jan; 36(1):139-42.
Last reviewed September 2018 by EBSCO Medical Review Board Teresa Briedwell, PT, DPT, OCS, CSCS
Last Updated: 8/10/2015
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