Date of Award

2014

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Psychology

Abstract

Background: A healthy 21 year old male football player with no history of finger injury or deformity presented to a team athletic trainer with a proximal and distal phalanx deformity of the left fourth digit immediately after jamming his finger while making a block in practice. Flexion deformity of the proximal interphalangeal (PIP) joint and extension deformity of the distal interphalangeal (DIP) joint were immediately present. Significant swelling was also noted. No pain existed upon palpation of the PIP joint. Varus and valgus ligamentous tests were negative. Passive range of motion was fully intact, and active flexion was available within a reduced range compared to the opposite side. The athlete was able to fully actively extend the PIP joint. Differential Diagnosis: Possible diagnoses were boutonniere deformity, volar plate tear, and lateral collateral ligament sprain. Treatment: Fluoroscopy was negative for fracture or bony deformity. Final diagnosis by the team physician was central slip injury based on presentation of boutonniere deformity. The team orthopedist specializing in hand conditions was contacted following the injury to determine initial treatment procedure. The physician indicated that the injury should be treated with full finger splinting for approximately four weeks, during which time full participation would be allowed. Uniqueness: Boutonniere deformity typically occurs chronically and once developed, precludes active PIP extension. In this case, the boutonniere deformity both developed acutely and retained active PIP extension. Conclusion: Boutonniere deformities have the potential for permanent disfigurement and dysfunction, particularly when chronic. Acute boutonniere deformity treatment and return to play guidelines are lacking in the literature; yet outcomes for the current case suggest that regardless of onset or available motion, suspected closed central slip injuries should be treated conservatively with splinting in order to prevent boutonniere deformity.

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