What is a stage two boutonniere finger deformity? This is what my wife has been diagnosed with. We understand what causes the fingers to get stuck like this. What we are trying to decide now is what kind of treatment would be best for her. The surgeon told us it depends on the stage but didn't elaborate beyond that.
Treatment for Boutonniere finger deformities depends on how severe the deformity is, how much motion there is at each joint, and whether or not the joint can be passively straightened. Fingers that can be stretched or moved back to their normal resting position may benefit from hand therapy and splinting.
But fingers that are in a Boutonniere position and can't be moved to a normal position are considered contracted. Surgery becomes the only option at that point. The surgical choices include synovectomy, tenotomy, or reconstruction of the extensor tendon.
If the deformity is severe, then a joint fusion (called arthrodesis) or joint replacement (arthroplasty) may be required. These two procedures are referred to as salvage surgery).
Surgeons use a special classification system to decide just how severe is the deformity and therefore which surgical procedure to choose. There are three stages of Boutonniere deformity. Stage one (mild) is correctable with passive motion. The joint surface is normal without any signs of joint damage or degeneration.
Stage two Boutonniere deformity is considered moderate in severity. The joints can be partially returned to their normal anatomic position (neutral). And the articular (joint) surface remains unchanged. In the early phase of stage two deformity, it may still be possible to convert to a stage one deformity with conservative (nonoperative) care.
Stage three is defined by a fixed contracture (does not correct with passive motion) and the joint surface is damaged to the point of destruction. This is the stage that most often requires surgical intervention.
Stages one and two may still respond to hand therapy, splinting, and/or steroid injection of the joint. If stage one and stage two deformities fail to respond to conservative care, then surgery may be recommended for them, too.
When choosing the surgical technique for each patient, the surgeon takes into consideration the condition of the most affected joint, the adjacent joints, the skin, joint motion, and overall hand function. Every effort is made to restore as much normal motion as possible to the joints affected.
Keoni Williams, MD, and Andrew L. Terrono, MD. Treatment of Boutonniere Finger Deformity in Rheumatoid Arthritis. In The Journal of Hand Surgery. August 2011. Vol. 36A. No. 8. Pp. 1388-1393.
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