Central Slip Tear (Boutonniere Deformity)

What is Central Slip Tear (Boutonniere Deformity)?

What Is a Central Slip Tear?

A central slip tear, commonly referred to as Boutonnière deformity, is a specific type of injury affecting the extensor tendon of the finger. This injury involves the rupture of the tendon as it travels over the middle joint, known as the proximal interphalangeal (PIP) joint. The central slip is a part of the extensor mechanism that plays a crucial role in the extension of the finger.

Causes and Mechanism of Injury

Boutonnière deformity typically results from a direct impact to the finger by a solid object, such as a basketball or football. The injury occurs when:

• Direct Trauma: A forceful blow to the finger causes it to flex (bend forward) beyond its normal range of motion.
• Excessive Force: The force exerted on the finger stretches or ruptures the extensor tendon that attaches to the PIP joint.
  The excessive flexion leads to the central slip tearing, which disrupts the normal function of the tendon.

Symptoms and Clinical Presentation

A central slip tear manifests through a series of distinct symptoms and changes in finger appearance:

• Deformity: The most noticeable feature of Boutonnière deformity is the characteristic finger deformity where the distal interphalangeal (DIP) joint bends inward, while the PIP joint remains straight. This results in a “buttonhole” appearance.
• Pain: The initial injury often causes significant pain in the affected finger.
• Swelling and Bruising: Swelling and bruising around the PIP joint are common following the injury.
• Impaired Function: Difficulty in extending the finger fully and performing gripping or pinching motions is typical.

Diagnosis and Evaluation

Accurate diagnosis of a central slip tear involves:

• Physical Examination: Our Baulkham Hills Chiropractor will examine the finger, assessing range of motion, pain, and the characteristic deformity.
• Imaging Studies: X-rays or MRI scans may be used to confirm the diagnosis and evaluate the extent of the tendon damage. These images help in visualising any associated bone injuries or complications.

Treatment Options

Effective management of Boutonnière deformity focuses on restoring normal finger function and preventing long-term complications. Treatment strategies include:

• Conservative Management:
  • Immobilisation: A splint or brace is used to keep the PIP joint in a straight position and allow the central slip to heal. The splint is typically worn for several weeks.
  • Rest and Ice: Initial care involves rest, ice application, and elevation to reduce pain and swelling.
• Rehabilitation:
  • Physical Therapy: After the initial healing period, physical therapy is crucial for restoring strength, flexibility, and range of motion in the finger. Rehabilitation exercises focus on improving finger extension and overall hand function.
• Surgical Intervention:
  • Surgical Repair: In severe cases or if conservative treatments fail, surgical repair of the extensor tendon may be necessary. The procedure aims to reattach the torn tendon and restore normal function.

Prevention Strategies

To reduce the risk of Boutonnière deformity and similar injuries:

• Protective Gear: Use appropriate hand and finger protection during sports and activities with a high risk of injury.
• Proper Technique: Employ correct techniques when handling objects or participating in sports to reduce the risk of trauma to the fingers.
• Strengthening Exercises: Engage in regular exercises to strengthen the tendons and ligaments of the fingers, enhancing their resilience to injury.

Conclusion

A central slip tear, or Boutonnière deformity, is a significant injury that can impact hand function and daily activities. Understanding the causes, symptoms, and treatment options is essential for effective management and recovery. Early diagnosis and appropriate treatment can help restore finger function and prevent long-term deformity.

If you are suffering from Central Slip Tear, we have a team who is ready to help you and get you on the road to recovery. Book an appointment with Precision Health today! Call us on (02) 9639 7337 or book online.

National Center for Biotechnology Information (NCBI), 2018. Overview of Orthopedic Disorders. [online] Available at: https://www.ncbi.nlm.nih.gov/books/NBK459181/ [Accessed 6 August 2024].

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