Boutonniere deformities in rheumatoid arthritis

The emphasis in rheumatoid hand surgery has been on the MP joints, but the PIP joints are often involved with the boutonniere deformity being one common pattern. The pathology of the boutonniere begins with a synovitis of the joint, followed by elongation al the central slip, subluxation of the later bands, and contracture of the retinacular ligaments. Treatment in the early stages can include synovectomy and tendon reconstruction. In the later stages, when the joint is fixed or there is articular surface damage, a joint replacement or arthrodesis is necessary.