Boutonniere deformity: Difference between revisions
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{{Hand and finger injury DDX}} | {{Hand and finger injury DDX}} | ||
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*Elson’s test: bend PIP 90 deg over edge of table, extend middle phalanx against resistance. Should have weak PIP extension and DIP goes rigid as lateral bands have to work. | *Elson’s test: bend PIP 90 deg over edge of table, extend middle phalanx against resistance. Should have weak PIP extension and DIP goes rigid as lateral bands have to work. | ||
Revision as of 21:15, 21 July 2016
Background
- Extensor Zone III Injury over the PIP joint.
- Most commonly central tendon is injured, causing FDS to be unopposed, thus causing flexion of PIP
- Disruption of central tendon causes lateral bands to be displaced volarly, causing them to act like flexors
- FDP still intact
Clinical Features
- History of trauma to digit and painful PIP.
- Forced flexion of actively extended finger
- Direct blow to PIP
- Jamming
- Laceration distal to PIP can injure central tendon
- On exam, will see hyperflexion of PIP with hyperextension of DIP and MP joints.
Differential Diagnosis
- Rheumatoid Arthritis
- Volar PIP dislocation
- Flexion contracture of PIP joint
Hand and finger injuries
- Distal finger
- Other finger/thumb
- Boutonniere deformity
- Mallet finger
- Jammed finger
- Jersey finger
- Trigger finger
- Ring avulsion injury
- De Quervain tenosynovitis
- Infiltrative tenosynovitis
- Metacarpophalangeal ulnar ligament rupture (Gamekeeper's thumb)
- Hand
- Wrist
- Drummer's wrist
- Ganglion cyst
- Lunotriquetral ligament instability
- Scaphoid fracture
- Extensor digitorum tenosynovitis
- Compressive neuropathy ("bracelet syndrome")
- Intersection syndrome
- Snapping Extensor Carpi Ulnaris
- Vaughn Jackson syndrome
- General
Evaluation
- Elson’s test: bend PIP 90 deg over edge of table, extend middle phalanx against resistance. Should have weak PIP extension and DIP goes rigid as lateral bands have to work.
- Positive test indicated rupture of central tnedon slip.
Management
- XR to assess for avulsion fracture of middle phalanx
- If open or with displaced avulsion fracture: operative repair
- Closed: splint in extension (Both DIP and PIP) for up to 6 weeks, refer to hand surgeon. NO flexion of DP permitted for duration of splinting, including during cleaning. Repair extensor tendon if injured.
Disposition
- Hand specialist follow up if closed injury
- Immediate consult if deformity is caused by open injury