Boutonniere Deformity Elson's Test - Everything You Need To Know - Dr. Nabil Ebraheim
Educational video describing the condition boutonniere finger deformity.
It is a chronic deformity characterized by PIP flexion. Chronic injury to the extensor tendon or central slip usually prevents the finger form active extension.
Clinical examination
The extensor tendon of the finger splits into the lateral bands. The lateral bands then come together and insert into the base of the distal phalanx. The central slip inserts into the base of the middle phalanx. If the central slip becomes ruptured, the lateral bands will slip down to a volar position causing flexion of the PIP.this injury can be missed and may result in a chronic flexion deformity of the PIP joint. A volar dislocation of the PIP joint is associated with a central slip tear. The PIP must be stabilized in extension.
Elson’s test
Used to determine if the patient has a central slip tear before the deformity is present. The patient is asked to curl the affected finger around the edge of a table. (the PIP is bent 90 degrees over the edge of the table). The examiner then places their finger over the middle phalanx. The patient is then asked to extend the finger. If the central slip is intact, the examiner will be able to feel the tension of the finger being extended. With a ruptured central slip, the examiner will not feel the tension, as the patient will be unable to extend the PIP joint.
Treatment
Nonoperative: place the PIP in full extension with a splint
Surgical indications:
•Surgery is indicated in selected cases after failure of extension splinting trial at least 3 months.
•The full passive range of motion of the PIP and DIP be present.
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