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Extensor tendon injuries
Published in Peter Houpt, Hand Injuries in the Emergency Department, 2023
In most cases, this tendon injury is only recognized after a Boutonnière deformity has established. The late correction of a Boutonnière deformity is often a disappointing procedure which rarely leads to good results.
Physical Examination of the Hand
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
Examination of individual joints and associated deformities is an essential part of physical examination:Boutonnière deformity
Hands
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
Zone 3 injury – open or closed, with or without avulsion The boutonnière deformity is caused by disruption of the central slip at the PIPJ, which results in loss of extension at the PIPJ (often, weak PIPJ flexion is still possible with intact lateral bands) and hyperextension at the DIPJ.The deformity usually appears 10–14 days after the initial injury, especially after closed rupture as the TRLs stretch and the lateral bands move anterior to the PIPJ axis, becoming a PIPJ flexor and DIPJ hyperextensor. The initial treatment for closed injury should be splinting with the PIPJ in extension. The surgical indications for a closed boutonnière deformity are as follows: Displaced avulsion fracture at the base of the MP.Instability of the PIPJ associated with loss of active or passive extension of the joint.Failed non-operative treatment.Tendon can be repaired with simple mattress.
Functional reconstruction of a hand that was severely deformed due to Jaccoud’s arthropathy
Published in Modern Rheumatology Case Reports, 2021
Kei Funamura, Hajime Ishikawa, Rika Kakutani, Asami Abe, Hiroshi Otani, Kiyoshi Nakazono, Akira Murasawa
Deformity in both hands and forefeet gradually appeared and progressed without significant pain over three years after the onset. Since painful callosities developed on the planter aspect of both forefeet, she underwent forefoot reconstruction of both feet 13 years after the onset. The next year, our hospital received a referral for surgical treatment of severe deformity of both hands. Until that point, she had not received any anti-rheumatic drugs. While there was no active arthritis and no bone erosion in the joints of the whole body, severe deformity was observed in both hands (Figure 1). In the right hand, the MP joint of the index through the little fingers was dislocated palmo-ulnarly with flexion contracture of about 120° and a swan-neck deformity (Table 1). The palmar skin crease was deeply digging into the skin and was soggy. Severe boutonnière deformity of the thumb with adduction contracture at the carpometacarpal (CM) joint and the palmo-radially dislocated MP joint was also noted. Due to her severely deformed hand, she was unable to grasp large objects or show her hand in public (Figure 2). She complained that she was unable to put on gloves, grasp the handle of a kitchen knife, or use clothespins. She also had difficulty opening lids and driving a car because of her inability to grasp a steering wheel. No structural damage was found in the large or medium-sized joints throughout the rest of her body.
Volar transfer of the lateral band with transverse retinacular ligament is effective for the correction of swan-neck deformity caused by volar plate injury of the PIP joint
Published in Modern Rheumatology Case Reports, 2020
Masahiro Sato, Taku Suzuki, Takuji Iwamoto, Noboru Matsumura, Hiroo Kimura, Kazuki Sato, Masaya Nakamura, Morio Matsumoto
There are some concerns about this method. First, care must be taken not to transfer the lateral band too far volar, which can lead to boutonniere deformity. Proper tendon balancing should be determined after the suture of the transverse retinacular ligament with intraoperative active motion of the patient’s finger. Second, recurrence of swan-neck deformity was not observed one year postoperatively through direct suture of the volar plate was not performed. This is because the volar transfer of the lateral band prevents hyperextension of the PIP joint. However, potential recurrence of the deformity should be monitored carefully over a long follow-up period. Third, contracture of the lateral band is not improved with our method. The release of the lateral band is necessary when an intrinsic tightness test shows positive findings. We consider that a patient with intrinsic tightness or severe deformity (either passive correction of the deformity is impossible or there is excessive extension of the PIP joint) is not a good candidate for this technique. Further studies with more subjects are necessary to explore the indications and effectiveness of this technique.
Arthrodesis of the digital joint using intraosseous wiring in patients with rheumatoid arthritis
Published in Modern Rheumatology, 2021
Yumi Nomura, Hajime Ishikawa, Asami Abe, Hiroshi Otani, Satoshi Ito, Kiyoshi Nakazono, Akira Murasawa
A woman in her 40s had severe boutonnière deformity in the right ring and little fingers and difficulty in grasping large objects. Arthrodesis in a functional position was performed using intraosseous wiring. The PIP joint in the ring finger was fixed at 50° of flexion, and that in the little finger was fixed at 55° of flexion. A soft wire in the right ring finger had to be removed at four months after surgery due to skin ulcer, and in the little finger, a soft wire was also had to be removed at nine months due to skin irritation of a K-wire. An ulnar gutter splint was worn for 8 weeks after surgery and bony union was obtained at four months after surgery. The prehensile pattern improved, and she was able to grasp large objects.