Boutonniere deformity

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Boutonniere deformity Classification and external resources
Human hand bones (Joints visible but not labeled.)
ICD-10	M20.0
ICD-9	736.21
eMedicine	orthoped/24

Boutonniere deformity is a deformed position of the finger, in which the joint nearest the knuckle is permanently bent toward the palm while the furthest joint is bent back away (PIP hyperflexion with DIP hyperextension). It is commonly caused by injury or inflammatory conditions like rheumatoid arthritis.

[edit] Stages

1. Mild extension lag, passively correctable
2. Moderate extension lag, passively correctable
3. Mild flexion contracture
4. Advanced flexion contracture

Higher numbers indicate a more severe problem and greater likelihood of a poor final outcome

[edit] Pathophysiology

This flexion deformity of the proximal interphalangeal joint is due to interruption of the central slip of the extensor tendon such that the lateral slips separate and the head of the proximal phalanx pops through the gap like a finger through a button hole (thus the name, from French boutonnière "button hole"). The distal joint is subsequently drawn into hyperextension. This deformity makes it difficult or impossible to extend the proximal interphalangeal joint.

[edit] External links

• Duke Orthopedics boutonniere_deformity_of_the_thumb_mp_joint
• http://medicine.ucsd.edu/clinicalimg/upper-hand-boutonniere.html
• http://www.merck.com/mmpe/sf/multimedia/Photo2sec04ch34/t/sec04-ch034-ch034b.html

v • d • e Diseases of the musculoskeletal system and connective tissue (M, 710-739) Arthropathies Arthritis (Septic arthritis, Reactive arthritis, Rheumatoid arthritis, Psoriatic arthritis, Felty's syndrome, Juvenile idiopathic arthritis, Still's disease) - crystal (Gout, Chondrocalcinosis) - Osteoarthritis (Heberden's node, Bouchard's nodes) acquired deformities of fingers and toes (Boutonniere deformity, Bunion, Hallux rigidus, Hallux varus, Hammer toe, Swan neck deformity) - other acquired deformities of limbs (Valgus deformity, Varus deformity, Wrist drop, Foot drop, Flat feet, Club foot, Unequal leg length, Winged scapula) patella (Luxating patella, Chondromalacia patellae) Protrusio acetabuli - Hemarthrosis - Arthralgia - Osteophyte Systemic CT disorders vasculitis: Churg-Strauss syndrome - Kawasaki disease - Hypersensitivity vasculitis - Wegener's granulomatosis - Arteritis (Polyarteritis nodosa, Takayasu's arteritis, Temporal arteritis) immune/autoimmune: Goodpasture's syndrome - Microscopic polyangiitis - Systemic lupus erythematosus (Drug-induced) - Dermatomyositis (Juvenile dermatomyositis) - Polymyositis - Scleroderma - Sjögren's syndrome - Behçet's disease - Polymyalgia rheumatica - Eosinophilic fasciitis Hypermobility Dorsopathies spinal curvature (Kyphosis, Lordosis, Scoliosis) - Scheuermann's disease - Spondylolysis - Torticollis - Spondylolisthesis Spondylopathies (Ankylosing spondylitis, Spondylosis, Spinal stenosis) - Schmorl's nodes - Degenerative disc disease - Coccydynia - Back pain (Radiculopathy, Neck pain, Sciatica, Low back pain) Soft tissue disorders muscle: Myositis (Pyomyositis) - Myositis ossificans (Fibrodysplasia ossificans progressiva) synovium and tendon: Synovitis/Tenosynovitis (Calcific tendinitis, Stenosing tenosynovitis, Trigger finger, DeQuervain's syndrome) - Irritable hip - Ganglion cyst bursa: bursitis (Olecranon, Prepatellar, Trochanteric) - Baker's cyst fibroblastic disorders: Dupuytren's contracture - Fasciitis (Plantar fasciitis, Nodular fasciitis, Necrotizing fasciitis) - Fibromatosis shoulder lesions: Adhesive capsulitis - Rotator cuff tear - Subacromial bursitis enthesis: enthesopathies (Iliotibial band syndrome, Achilles tendinitis, Patellar tendinitis, Golfer's elbow, Tennis elbow, Metatarsalgia, Bone spur, Tendinitis) other, NEC: Muscle weakness - Rheumatism - Myalgia - Neuralgia - Neuritis - Panniculitis - Fibromyalgia Osteopathies disorders of bone density and structure: Osteoporosis - Osteomalacia - continuity of bone (Pseudarthrosis, Stress fracture) - Monostotic fibrous dysplasia - Skeletal fluorosis - Aneurysmal bone cyst - Hyperostosis - Osteosclerosis Osteomyelitis - Avascular necrosis - Paget's disease of bone - Algoneurodystrophy - Osteolysis - Infantile cortical hyperostosis Chondropathies Juvenile osteochondrosis (Legg-Calvé-Perthes syndrome, Osgood-Schlatter disease, Köhler disease, Sever's disease) - Osteochondritis - Tietze's syndrome - Relapsing polychondritis See also congenital conditions (Q65-Q79, 754-756)