Boutonnière Deformity of Finger

(BD; Buttonhole Deformity; Central Slip Disruption; Central Slip Injury; Deformity of Finger, Boutonnière; Extensor Tendon Rupture; PIP Joint Sprain)


Boutonnière deformity (BD) prevents you from straightening your finger. The disorder affects the finger’s system of tendons. The tendons allow you to flex and straighten your finger.
Tendons in Finger
Finger Tendon
Copyright © Nucleus Medical Media, Inc.


In BD, the tendon on the top of the finger (called the central slip) is torn or cut from the other tendons. This creates a tear that resembles a buttonhole (or boutonnière in French). The first finger joint is forced down and the fingertip bends back at the second joint. The tendons on this part of the finger are flat and thin. They are prone to injury. If you have BD in the thumb, it affects a joint called the metacarpophalangeal (MCP). BD can be caused by:
  • A powerful blow to the finger
  • A cut to the finger’s central slip
  • An injury to the first finger joint—called the proximal interphalangeal (PIP) joint
  • A severe burn on the hand

Risk Factors

Factors that may increase your risk of developing BD include:


Symptoms may include:
  • Pain and swelling on the top of the finger’s middle joint—the PIP joint
  • Inability to straighten the finger at the middle joint
  • Sign of injury (such as fracture or dislocation) to the PIP joint
  • Sign of injury (such as fracture or dislocation) to the MCP joint if the thumb is involved

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