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Boutonnière deformity

Last revised by Leonardo Lustosa on 21 Jun 2022

Boutonnière deformity is the eponymous name of a musculoskeletal manifestation of rheumatoid arthritis presenting in a digit, with the combination of:

  • flexion contracture of a proximal interphalangeal (PIP) joint
  • extension of a distal interphalangeal (DIP) joint

Boutonnière deformities occur when the central slip of the extensor digitorum tendon is torn or stretched resulting in PIP joint flexion. Increasing PIP joint flexion causes further extensor retinaculum damage resulting in "buttonholing" of the proximal phalanx between the lateral bands of the extensor tendon. Secondary DIP joint extension then occurs 4.

"Boutonnière" is French for buttonhole. With the loss of integrity of the central aspect of the extensor tendon at the PIP joint, the PIP joint flexes, passing between the lateral bands just as a button passes through the buttonhole of a shirt.

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Cases and figures

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