Boutonnière Finger

Presentation

After jamming the tip of a partially or fully extended finger (resulting in hyperflexion of the proximal interphalangeal [PIP] joint) or with direct trauma over the joint, the patient develops a painful, swollen PIP joint. These injuries are seen in basketball players and martial artists, who use open-hand blocking techniques, as well as when an athlete’s hand is stepped on or after a volar dislocation at the PIP joint.

Tenderness is greatest over the dorsum of the base of the middle phalanx, and there is diminished extensor tendon strength with pain when the middle phalanx is extended against resistance. The classic boutonnière deformity is rarely present immediately after injury ; therefore early recognition and intervention are key to preventing this deformity from developing. Radiographs are usually normal.