How To Treat Boutonnière Deformity

A boutonnière deformity, also called a central slip injury, is a common condition typically associated with injury to the fingers by blunt force impacts, dislocations, fractures, and lacerations. Other bone afflicting conditions, such as rheumatoid arthritis and osteoarthritis, can also result in a boutonnière deformity. It is marked by an inability to straighten the finger due to an injury of the tendons that attach to the middle joint. Signs and symptoms can appear instantly following injury or up to three weeks later. Prompt medical care is vital since prolonged injury can result in irreversible deformity and loss of function. Get to know the best methods of treating a boutonnière deformity now.

Splinting

Early treatment is important to restoring the finger to its complete range of motion. Splints are placed at the middle joint of the finger with the aim of straightening it through pressure and immobilization of the finger. In this position, the edges of the tendons stay together to promote healing, in addition to allowing the end joint to bend. Splints must be used as directed. Patients are often required to keep them on continuously for three to six weeks, and at night once the initial injury has healed. Acute causes of a boutonnière deformity often respond well to the use of a splint, resulting in a full recovery. This method is less effective on older injuries, as the extended time between incident and treatment may result in a permanent loss of normal function.

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Finger Exercises

The finger comes equipped with several tendons whose purpose is to help with stretching or bending. If an injury occurs to any one of these tendons, the finger may lose the ability to bend itself. Such is the case with a boutonnière deformity. Stretching exercises may be ordered by a healthcare provider, frequently a physical therapist, since a boutonnière deformity can have a negative impact on finger mobility. The exercises are designed to first target barriers to mobility and improve flexibility followed by a focus on strength training. Exercises can include the lifting and lowering of a finger from the point of the knuckle or bending at the fingertip and then straightening it back. Physical therapy may also be required after surgical treatment to control the swelling and pain, which are common after a procedure. During this time, in addition to flexibility and strength training, patients may be required to do exercises that mimic their everyday tasks to better transition them back to full use.

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Medications

Individuals who have a boutonnière deformity often complain of both swelling and pain. These are symptoms other treatment methods may not ease. Healthcare providers may choose to order drugs to target and reduce inflammation. Often, providers will use medications in tandem with other treatments such as splints and exercises. Injections of corticosteroids are common practice, as they are good at tackling swelling. Drugs may also be recommended for pain. If a healthcare provider places a patient on a drug regimen, the patient should be sure to take them only as directed. If patients are interested in adding to or changing their drug therapy, they must discuss it with their doctor first to ensure all drugs they take are safe based on their current health parameters.

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Surgery

The preferred treatment of a boutonnière deformity involves nonsurgical options, however, in severe cases, surgical intervention may be required. Injuries warranting such treatment include lacerations that penetrate the skin, severing of the tendon, displacement of large bone pieces, and complications resulting from advanced rheumatoid arthritis. By way of surgical means, damage to the tendons and joints of the finger can be repaired, thus reducing pain and improving functionality. This can be done many ways including cutting into damaged tendons, replacing part of a damaged tendon with a healthy one, and implementing wire or screws to straighten out the joints. Recovery can take up to three months, with limited use of the attached hand.

However, even with surgical intervention, the condition may not fully resolve, and the finger may never regain its original appearance. This is because the longer the finger has gone untreated, the more difficult it becomes to treat. Should all other treatments fail, a joint fusion may be considered, through which two surfaces of the joint are bound together relieving pain, increasing stability, and guarding against further deformity.

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Protecting The Finger

Protecting the finger is typically done in conjunction with all of the other methods of treatment, especially wearing a splint. It is vital to guard the finger against re-injury especially during the first few weeks of treatment. Patients may also be asked to modify how they use their hand in daily activities to deal with and prevent a boutonnière deformity. This is doubly important if they have an active lifestyle, such as engaging in sports. Finger guards come in a variety of forms, from those designed for a single finger to those that cover the whole hand. Doctors may even recommend the use of a specialty splint or tape designed to provide more protection.