Rheumatoid Hand: Boutonniere Finger Deformity


Boutonniere finger deformity is characterized by proximal interphalangeal (PIP) joint flexion, distal interphalangeal (DIP) joint extension, and hyperextension of the metacarpophalangeal (MCP) joint, with volar subluxation of the lateral bands. The deformity is common in patients with rheumatoid arthritis; however, it is not specific to this disorder and may occur following trauma or other inflammatory arthritides. Treatment of boutonniere finger is individualized and is based on the patient's current level of function, deformity, medical status, limitations of the surgeon, and expectations. Not all patients with rheumatoid hand deformities are candidates for surgery because many will adapt over time and achieve an acceptable functional level. Nonsurgical management is indicated for patients with early stage disease and consists of nighttime splinting of the PIP joint in extension. Additionally, a corticosteroid injection is useful if active PIP joint synovitis is present. A variety of surgical procedures are available for boutonniere finger deformity, including tenotomy of the terminal extensor tendon and reconstruction of the central slip. The choice of surgical treatment is based on the flexibility of the PIP joint and the status of the articular cartilage.

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