Boutonniere Deformity of the Finger

[Bombesin]

A buddy of mine thought he "jammed" his finger but went to get it looked at because it didn't get much better. No fracture, but he was told he might have a mild boutonniere deformity. "Maybe" a central slip injury. It tends to straighten on its own after being "loosened up." Ortho gave him a splint for 3 weeks and said surgery is a possibility. My question for the MSK guys here: what is the physiatric approach to treating boutonniere deformity? Are there any hand/finger exercises that can aid in his recovery and allow him to possibly avoid surgery? Is 3 weeks in a splint enough, or do you recommend more like 6?

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[RUOkie]

Personally, I use 6 weeks in a splint with NO ROM. They need to keep the splint on 24/7 and when bathing make sure the finger is straight. If they bend it, time starts over. (I treat it exactly like a mallett finger). Often, surgery is still needed.

 

[dc2md]

Although I've never seen this in clinic, RUOkie is spot on! Here's the ring splint to use: http://www.amazon.com/Oval-8-Splint-Point-Products-Individual/dp/B000ITHTZW
**no, I don't have a financial interest in this product

The problem is an avulsed tendon (or cut) on the proximal part of the middle phalanx. Over time, the PIP goes into flexion, and the central slip slips down over the sides of the PIP and hold it there. So what this splint does is keep the PIP (proximal interphalangeal joint) in extension....with hopes of abuting the two ends of the torn tendon (or the tendon with its original insertion point). So of course taking the splint off AT ALL will separate these healing ends, ruin the new collagen being laid down, and require you to start all over. But if your buddy makes a mistake and accidentally bends that PIP, I'd tell him to fess up and restart the 6-wk splinting...instead of going for surgery b/c you didn't want to be honest to the orthopedist (in this case).

But to answer the other question you had, no, don't do any exercises with that finger. And post a picture if you have one...those are always fun to look at. 🙂