Pain and swelling at the middle joint
Often follows a jam, dislocation or cut over the joint.
Central slip injury · Finger deformity
Boutonnière Deformity Treatment in Manchester
A bent middle finger joint with the fingertip drifting backward can develop after a jammed finger, cut or inflammatory arthritis. Early assessment of the central slip may allow splint treatment before the deformity becomes fixed.
Bent middle jointFingertip hyperextensionJammed fingerCentral slip injury
Manchester · UKUK-trained specialist · Manchester, UAE & UK consultations
Patient guideSymptoms → Diagnosis → Treatment → Recovery
Specialist hand & wrist assessment
What is it?
Failure of the central slip causes the middle joint to bend and the fingertip joint to hyperextend.
Early treatment
Continuous splinting of the middle joint straight, usually for 6–8 weeks.
Why act early?
A flexible early deformity is generally easier to correct than a fixed chronic one.
When surgery?
Cut tendon, displaced fracture, rheumatoid disease, failed splinting or fixed deformity.
Understanding the condition
What is a boutonnière deformity?
The central slip is part of the extensor tendon mechanism that straightens the proximal interphalangeal (PIP) joint. When it is torn or divided, the PIP joint bends while the lateral bands shift and pull the fingertip joint into hyperextension.
The deformity may not be obvious immediately after injury. Pain, swelling and difficulty straightening the middle joint can precede the classic posture.
Clear diagnosis before treatmentSimilar symptoms can arise from the neck, elbow, wrist, tendons or joints. The examination is designed to locate the true source.
What patients may notice
Symptoms worth checking early.
Symptoms vary with the tendon or finger structure involved and how long function has been affected. Persistent locking, weakness, deformity or loss of movement deserves specialist assessment.
Difficulty straightening the PIP joint
Active extension becomes weak or impossible.
Fingertip hyperextension
The end joint may bend backward as the deformity progresses.
Delayed deformity
The classic posture may appear days or weeks after injury.
Stiffness
A chronic deformity may no longer correct fully with passive movement.
Associated arthritis
Inflammatory arthritis can create a similar tendon imbalance.
Why it happens
What causes boutonnière deformity?
A useful consultation connects the symptom pattern to the exact tendon, pulley or joint involved—not just the label.
Jammed finger
A forceful bend at the middle joint can tear the central slip.
Laceration
A cut over the back of the PIP joint can divide the tendon.
PIP dislocation or fracture
Joint injury may disrupt the tendon insertion or remove a bone fragment.
Rheumatoid arthritis
Inflammation can weaken the extensor mechanism and produce deformity.
Focused diagnosis
Find the structure, the injury and the severity.
Assessment determines whether the central slip is injured, whether the deformity remains flexible and whether fracture, dislocation or inflammatory arthritis is present.
Bring to your appointmentPrevious reports, imaging, operation notes, splints and information about work or activities that trigger symptoms.
Injury and deformity history
Timing, mechanism and progression are documented.
Joint position and flexibility
Active and passive PIP and DIP movement are compared.
Central slip testing
Specific examination manoeuvres assess tendon continuity and balance.
X-ray
Imaging checks for fracture, joint alignment and arthritis.
Treatment choices
Start with the option that fits the diagnosis.
Surgery is not automatic. Treatment is matched to the exact tendon or finger problem, symptom severity, function and the patient’s goals.
Non-surgical care
Reduce irritation, protect function and review progress.
- Continuous PIP extension splintThe middle joint is held straight, usually for 6–8 weeks.
- Move the fingertip jointDIP bending exercises help the lateral bands glide correctly while the PIP stays straight.
- Night splintingA further period of night protection may follow full-time treatment.
- Hand therapyTherapy addresses swelling, stiffness, tendon balance and return to function.
- Arthritis managementInflammatory disease may require medication and rheumatology input in addition to splinting.
Surgical pathway
Restore tendon balance when the deformity cannot be corrected with splinting.
- Central slip repairA cut tendon may be repaired directly when appropriate.
- Bone or joint treatmentA displaced fragment or unstable joint may need fixation.
- Tendon reconstructionChronic fixed deformity may require reconstruction or staged correction.
- Joint procedure in advanced casesSevere painful arthritis or stiffness may need a different surgical solution.
Surgery when appropriate
Boutonnière deformity surgery
Nonsurgical treatment is preferred when the deformity is flexible and the tendon is not openly divided. Surgery is considered for selected cuts, fractures, rheumatoid deformity, failed splinting or fixed chronic cases.
- Assess flexibility, tendon continuity and joint condition
- Treat acute wound or fracture when present
- Repair or reconstruct the extensor mechanism
- Protect the PIP joint in the correct position
- Progress therapy while maintaining tendon balance
Realistic expectationsSurgery can improve function and alignment but may not fully restore a chronic finger to a normal appearance. Stiffness and recurrent deformity remain possible.
Specialist pathwayDiagnosis → Procedure → Therapy → Recovery
Recovery pathway
Healing is staged—not rushed.
Timelines are guides only. The diagnosis, procedure, wound, therapy programme, job and associated injuries all influence recovery.
First 6–8 weeks
The PIP joint is protected straight while prescribed fingertip exercises continue.
After full-time splinting
PIP movement is introduced gradually under therapy guidance.
Night protection
A night splint may continue while tendon balance and extension improve.
Longer term
Strength, swelling and stiffness can continue to improve for months; chronic cases recover more slowly.
4.96/555 verified reviewsWhy consult Dr. Arshad
A clear diagnosis. Practical options. A plan built around you.
Dr. Shoaib Arshad is a fellowship-trained consultant orthopaedic hand and wrist surgeon with UK specialist training and more than 17 years in orthopaedic surgery.
Focused hand, wrist and upper-limb assessmentNon-surgical and surgical treatment pathwaysConsultations in Manchester and across the UK, and at Healthpoint Abu Dhabi
Meet Dr. Arshad ↗Questions patients ask
Boutonnière Deformity FAQs.
General information only. Your diagnosis and treatment plan should be based on an individual medical assessment.
Can boutonnière deformity appear later after an injury?+
Yes. Central slip injury can initially look like a swollen jammed finger and the deformity may develop over days or weeks.
Why is the fingertip exercised while the middle joint is splinted?+
Bending the fingertip helps keep the lateral bands gliding in the correct position while the central slip heals.
Can a chronic deformity still be treated?+
Yes, but fixed chronic deformities are more complex. Treatment may involve serial splinting, therapy or reconstruction depending on flexibility and joint condition.
Does surgery make the finger completely normal?+
Not always. Surgery aims to improve function, alignment and pain, but stiffness or residual deformity may remain.
Can I get a specialist opinion in Manchester?+
Yes. Dr. Arshad provides specialist hand and wrist assessment in Manchester, UK and during UK clinical availability.
Medical referencesPatient information sources used for this guide
Manchester · UK & Abu Dhabi consultation availability
Ready for a clear tendon and finger assessment?
Book a specialist consultation and bring any previous imaging, reports, splints or treatment information.