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


Boutonnière deformity is damage to the tissue of the middle joint of the finger. It makes it hard to straighten the finger.

Tendons in the Finger
Finger Tendon
Copyright © Nucleus Medical Media, Inc.


This problem may be caused by:

  • A cut to the top of the finger
  • A blow to the top of a bent middle finger with an object, such as a ball
  • Weak tendons from health problems, such as rheumatoid arthritis

Risk Factors

Rheumatoid arthritis can raise your risk of this problem.


Symptoms may be:

  • A cut to the top of the finger
  • Pain and swelling
  • Problems opening straightening the finger
  • A change in the way the finger looks or feels


The doctor will ask about your symptoms and health history. A physical exam will be done, paying close attention to the finger. You may be asked how the injury happened.

An x-ray may be done to check for a fracture.


A splint will be needed to protect the finger as it heals. Other options are:


Medicine may be needed to ease pain and swelling. It may be given by mouth or with an injection.

Antibiotics may also be used to treat an infection.


Some people may need surgery to repair the tendon. Exercises will also be given to help with finger strength and motion.


This injury often happens due to accidents. There are no guidelines to prevent it.


National Institutes of Arthritis and Musculoskeletal and Skin Diseases 

Ortho Info—American Academy of Orthopaedic Surgeons 


Canadian Orthopaedic Foundation 

Canadian Physiotherapy Association 


Boutonniere deformity of the finger. Orthogate website. Available at: Published September 4, 2015. Accessed September 23, 2019.

Boutonniere deformity—emergency management. EBSCO DynaMed website. Available at: . Accessed September 23, 2019.

McMurtry JT, Isaacs J. Extensor tendons injuries. Clin Sports Med 2015. Jan;34(1):167-180.

Revision Information