Boutonnière deformity of the thumb without rheumatoid arthritis or trauma is not widely recognised. This study aimed to investigate its prevalence, relation to sex and age, and identifying factors associated with the extensor mechanism using ultrasonography. We examined 248 thumbs from 127 participants who were asymptomatic for hand disorders and had no history of hand injury. Boutonnière deformity was identified in 20 thumbs of 17 participants and was significantly more prevalent among elderly participants than among young participants. No significant differences in sex or hand dominance were noted. The deformity had a significant effect on range of motion and grip and pinch strengths. The extensor pollicis brevis (EPB) tendon was significantly narrower in affected thumbs than in non-affected thumbs. The prevalence of boutonnière deformity without rheumatoid arthritis or trauma was 13%, and the deformity was associated with advanced age and a narrow EPB tendon.
BrumfieldRHConatyJP. Reconstructive surgery of the thumb in rheumatoid arthritis. Orthopedics. 1980, 3: 529–33.
2.
BrunelliGABrunelliGR. Anatomy of the extensor pollicis brevis muscle. J Hand Surg Br. 1992, 17: 267–9.
3.
CardonLJTohSTsuboK. Traumatic boutonniere deformity of the thumb. J Hand Surg Br. 2000, 25: 505–8.
4.
ChurchillMCitronN. Isolated subluxation of the extensor pollicis longus tendon. A cause of ‘boutonnière’ deformity of the thumb. J Hand Surg Br. 1997, 22: 790–2.
5.
DawsonSBartonN. Anatomical variations of the extensor pollicis brevis. J Hand Surg Br. 1986, 11: 378–81.
6.
DiasJJSinghHPTaubNThompsonJ. Grip strength characteristics using force-time curves in rheumatoid hands. J Hand Surg Eur Vol. 2013, 38: 170–7.
7.
FeldonPTerronoALNalebuffEAMillenderLH. Rheumatoid arthritis and other connective tissue diseases. In: WolfeSWHotchkissRNPedersonWCKozinSH (Eds.) Green’s operative hand surgery, 6th ed. New York, Churchill Livingstone, 2010: 2056–8.
8.
HochJ. Early “90/90 deformity” of the thumb: pathogenesis and surgical correction. Eur J Plast Surg. 1995, 18: 18–23.
9.
JabirSLyallHIwuagwuFC. The extensor pollicis brevis: a review of its anatomy and variations. Eplasty. 2013, 13: e35.
10.
JenkinsMBambergerHBBlackLNowinskiR. Thumb joint flexion. What is normal?J Hand Surg Br. 1998, 23: 796–7.
11.
KeenHIWalefieldRJGraingerAJHensorEMEmeryPConaghanPG. Can ultrasonography improve on radiographic assessment in osteoarthritis of the hands? A comparison between radiographic and ultrasonographic detected pathology. Ann Rheum Dis. 2008, 67: 1116–20.
12.
Keon-CohenB. De Quervain’s disease. J Bone Joint Surg Br. 1951, 33: 96–9.
13.
KozlowJHChungKC. Current concepts in the surgical management of rheumatoid and osteoarthritic hands and wrists. Hand Clin. 2011, 27: 31–41.
14.
KulshreshthaRPatelSAryaAPHallSCompsonJP. Variations of the extensor pollicis brevis and its insertion: a study of 44 cadaveric hands. J Hand Surg Eur Vol. 2007, 32: 550–3.
15.
KwonBCChoiSJKohSHShinDJBaekGH. Sonographic identification of the intracompartmental septum in de Quervain’s disease. Clin Orthop Relat Res. 2010, 468: 2129–34.
16.
LaceyTIIGoldsteinLATobinCE. Anatomical and clinical study of the variations in the insertions of the abductor pollicis longus tendon, associated with stenosing tendovaginitis. J Bone Joint Surg Am. 1951, 33: 347–50.
17.
LandisJRKochGG. The measurement of observer agreement for categorical data. Biometrics. 1977, 33: 159–74.
18.
LeeKHKangCNLeeBGJungWSKim doYLeeCH. Ultrasonographic evaluation of the first extensor compartment of the wrist in de Quervain’s disease. J Orthop Sci. 2014, 19: 49–54.
19.
MathiessenAHaugenIKSlatkowsky-ChristensenBBøyesenPKvienTKHammerHB. Ultrasonographic assessment of osteophytes in 127 patients with hand osteoarthritis: exploring reliability and associations with MRI, radiographs and clinical joint findings. Ann Rheum Dis. 2013, 72: 51–6.
20.
MathiowetzVWeberKVollandGKashmanN. Reliability and validity of grip and pinch strength evaluations. J Hand Surg Am. 1984, 9: 222–6.
21.
NagaokaMMatsuzakiHSuzukiT. Ultrasonographic examination of de Quervain’s disease. J Orthop Sci. 2000, 5: 96–9.
22.
Navarro-CompánVLandewéRProvanSA. Relationship between types of radiographic damage and disability in patients with rheumatoid arthritis in the EURIDISS cohort: a longitudinal study. Rheumatology (Oxford). 2015, 54: 83–90.
23.
NayakSRHusseinMKrishnamurthyA. Variation and clinical significance of extensor pollicis brevis: a study in South Indian cadavers. Chang Gung Med J. 2009, 32: 600–4.
24.
RehimSAChungKC. Applying evidence in the care of patients with rheumatoid hand and wrist deformities. Plast Reconstr Surg. 2013, 132: 885–97.
25.
RoussetPVuillemin-BodaghiVLaredoJDParlier-CuauC. Anatomic variations in the first extensor compartment of the wrist: accuracy of US. Radiology. 2010, 257: 427–33.
26.
SteinABTerronoAL. The rheumatoid thumb. Hand Clin. 1996, 12: 541–50.
27.
TerronoAL. The rheumatoid thumb. J Am Soc Surg Hand. 2001, 2: 81–92.
28.
TerronoAMillenderLNalebuffE. Boutonniere rheumatoid thumb deformity. J Hand Surg Am. 1990, 15: 999–1003.
29.
ToledanoBTerronoALMillenderLH. Reconstruction of the rheumatoid thumb. Hand Clin. 1992, 8: 121–9.
30.
YoshidaRHouseHOPattersonRMShahMAViegasSF. Motion and morphology of the thumb metacarpophalangeal joint. J Hand Surg Am. 2003, 28: 753–7.
