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Wrist Boutonniere Deformity

The hand is a very complex anatomical structure that can sustain a variety of injuries depending on the mechanism of force applied and location of the injury. One particular wrist pain injury is called a wrist boutonniere deformity and is caused from a rupture of a specific area of soft tissue that arises from the extensor tendon of the finger. The extensor tendon traverses from the forearm, across the back of the hand and into the individual finger. Off of this extensor tendon mechanism there are divisions or bands that insert in different locations on the finger. There are 2 lateral or outer bands and one central band. Injury or rupture of the central band creates an altered pulling mechanism to the finger creating the wrist boutonniere deformity.

Nature and Mechanism of a Wrist Boutonniere Deformity

The wrist boutonniere deformity (also known as buttonhole) occurs commonly during sporting injuries typically with an end to end force of the finger against an oncoming object such as a football or basketball. This force causes abnormal forces on the central slip when the finger joint bends backward at the point of impact.

Hand Boutonniere Deformity

This hand pain injury can create a progressive bending of the first (PIP) finger joint with an over extension or straightening effect of the end (DIP) joint. This is usually evident when attempting to make a fist.

Often in this type of hand pain injury the extent of the soft tissue disruption is not appreciated and the deformity may not be immediately apparent. With this type of soft tissue injury the remaining uninjured lateral bands relocate to a more sideways position and begin acting in the opposite manner they were originally intended to. In the event the deformity is present for a long period of time, it may be difficult to correct.

Treatment Approach for Wrist Boutonniere Deformity
for Raleigh, Cary, Apex, Chapel Hill, Garner and Triangle Patients

In this type of hand boutonniere deformity the PIP joint of the finger is in a fixed bent or flexed position and will require splinting and prolonged stretching to regain the range of motion. Splinting and stretching of this type should avoid force application over the DIP joint which will only enhance the deformity.

There are additional range of motion and positioning techniques that allow for proper alignment of the misplaced bands. These techniques, if performed properly, allow for motion to be regained in the affected joints.

Lastly, healing of the central slip must take place and this can be achieved by properly splinting the finger completely straight for 3 weeks and then gradually adding dynamic splinting thereafter for up to a period of 3 months. While this is taking place, you should plan regular follow up visits with the therapist and physician to insure proper progress is being made.

On occasion, surgery may be required to physically correct the wrist boutonniere deformity, especially in chronic situations.

Postoperative wrist pain and stiffness may be a problem due to the complexities of the hand and the nature of the injury.

For more information on how the wrist boutonniere deformity specialists at Cary Orthopaedics can help you, contact us today at 919-467-4992 for an appointment!

Cary Orthopaedics serves patients from Raleigh, Garner, Cary, Apex, Holly Springs, Fuquay-Varina, Clayton, Chapel Hill, and Pittsboro, NC