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Boutonniere deformity: A complete guide

Do you ever get a forceful blow to your flexed(middle joint) finger? | What is boutonniere deformity? | Boutonniere splint | can a boutonniere deformity be fixed?

You will get the answer to all of these queries, below in this article.

Boutonniere deformity

In this case, we try to give you precise information on boutonniere deformity.

It can be defined as the situation in which an individual gets a forceful blow to his flexed (middle joint) finger and ultimately leads to the injury to the tendon that helps to straighten the middle joint of a finger.

In this case, there is a severed central slip tendon and you can also notice the flexion of the proximal interphalangeal (PIP) joint and extension of the distal interphalangeal (DIP) joint.

You may find a shortening of the oblique retinacular ligament.

Boutonniere deformity classification

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

Boutonniere deformity icd 10

  • M20.02 Boutonniere deformity
  • M20.021 Boutonniere deformitty of right finger(s)
  • M20.022 Boutonniere deformity of the left finger(s)
  • M20.029 Boutonniere deformity of an unspecified finger(s) 

Signs and symptoms

  • There is pain on grasping or tenderness.
  • There is inflammation around the joint.
  • In this case, this deformity leads to the flexion of the PIP joint and extension of the DIP joint.
  • Joint redness
  • A patient cannot fully extend his finger(extensor lag).

Possible contributing causes

  • A person may have a forceful blow to the flexed finger (trauma).
  • Rheumatoid arthritis can also be a possible cause.
  • Central slip tendon injury
  • Osteoarthritis is a known cause of many problems.
  • Infection

Differential diagnosis

  • It may be a fracture.
  • You may be suffering from gout.
  • Mallet finger
  • It may be a PIP joint flexion contracture.

Physical therapy intervention

  • You need to take a rest, to reduce inflammation.
  • Splinting the finger with the proximal interphalangeal joint held in extension.
  • Safety pin splinting is applied for approximately 4 to 6 weeks to help straighten the finger.
  • When we are addressing pain, we need to apply ice to that region.
  • When we are addressing pain, then we need to follow this process:-

Firstly, apply some Ice

Secondly, give Massage by following proper massage technique

Thirdly, go for Joint mobilization

In the fouth step, go for Electric stimulation

And lastly, apply Infrared 

  • If there is weakness and joint instability, we need to strengthen the extensors.
  • This deformity causes a lack of flexibility which can be cured by stretching techniques like intrinsic flexor stretching and fluid therapy.
  • We can perform joint mobilization of the Dip joint (glides and rotation).
  • In this case, you can also perform Soft tissue mobilization.

Conservative management

[Acute Injury: <3 weeks from initial injury]

Functional goals

  • A patient will be able to fully extend the finger to don/doff gloves.
  • He will be able to open his hand to place around a jar to open.


In this case, we got a piece of detailed information on boutonniere deformity.

Most importantly, if the injury is acute [Acute Injury: <3 weeks from initial injury], then we can follow the conservative treatment, briefly described in the video.

firstly, we give you an overview of boutonniere deformity.

secondly, we talk about signs and symptoms, diagnosis, etc.

And lastly, we give you the physical therapy intervention for the treatment of this deformity.

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