Diagnosis Explanation:

Boutonnière deformity occurs when the central slip of the extensor tendon on the back of the finger is injured, causing:

• Flexion at the PIP joint (middle knuckle bends inward).
• Extension at the DIP joint (tip of the finger bends outward).

This deformity can develop due to trauma (finger jam, laceration), arthritis (especially rheumatoid arthritis), or chronic wear on the tendon.

Symptoms:

• Inability to straighten the middle joint of the affected finger.
• Pain and swelling over the PIP joint.
• Stiffness and deformity progression if untreated.
• Weak grip strength in severe cases.

Specific Work Modifications:

• If your job requires typing or writing: Use ergonomic supports and take frequent hand-stretching breaks.
• If your job involves manual labor: Avoid gripping heavy objects, repetitive finger use, and direct pressure on the injured finger.
• If your job is desk-based: Use a split keyboard or adaptive mouse if needed to reduce strain.
• Avoid: Repetitive gripping, excessive typing, and tasks that strain the affected finger.

Specific Activity Modifications:

• If you play sports: Avoid ball-handling sports (basketball, volleyball, tennis) and heavy gripping (rock climbing, weightlifting).
• If you play an instrument: Modify technique to avoid overusing the injured finger.
• If you do crafting or gardening: Use adaptive tools with larger grips to reduce finger strain.
• Avoid: Forceful gripping, pushing movements with the affected finger, and high-impact activities.

Recommended Supplements:

• Collagen Peptides – 10g daily for tendon repair.
• Vitamin C – 500mg daily to support collagen synthesis.
• Glucosamine & Chondroitin – 1500mg/1200mg daily for joint lubrication and tendon health.
• Omega-3 Fatty Acids – 1000mg daily to reduce inflammation.
• Turmeric (Curcumin) – 500-1000mg daily for pain relief.

Recommended Nutrition and Hydration:

• Increase Lean Protein (chicken, fish, tofu, eggs) to support tendon healing.
• Eat Anti-Inflammatory Foods (berries, leafy greens, turmeric, nuts) to reduce swelling.
• Consume Hydrating Foods (cucumber, watermelon, citrus) to maintain joint flexibility.
• Limit Processed Foods & Sugars to prevent inflammation.
• Hydration: Drink 8-10 cups of water daily to support tendon health.

Home Exercise Prescription (Rehabilitation for Boutonnière Deformity)

Early Phase (0-2 Weeks, Immobilization & Reducing Pain):

• Splinting – Wear a PIP extension splint full-time for 6 weeks, as directed by your doctor.
• RICE Protocol – Rest, Ice (15-20 min, 3x/day), Compression, Elevation.
• Passive Finger Extension – Gently straighten the affected finger with the opposite hand, hold 10 seconds, repeat 10 reps, 2x/day.

Strengthening Phase (6+ Weeks, Restoring Mobility & Function):

• Towel Scrunches – Place a towel on a flat surface, use fingers to scrunch it, 10 reps, 2x/day.
• Finger Lifts – Place hand flat, lift each finger individually, 10 reps per finger, 2x/day.
• Rubber Band Finger Extensions – Wrap a rubber band around fingers, open hand against resistance, 10 reps, 2x/day.

Helpful Books:

1. Hand and Finger Exercises for Rehabilitation and Strength – Lauren S. Rashbaum, OT.
2. Arthritis and Hand Therapy: A Self-Help Guide to Managing Joint Pain – Susan J. Barnhart, PT.

Contact the Key West orthopedic clinic or reach out to Dr. Jason Pirozzolo.