694bb179_WRIST__2
[0] Boutonniere Deformity Test [1] Position the patient with the forearm in pronation and the hand relaxed on the table surface. [3] Grasp the proximal phalanx and stabilize the metacarpophalangeal joint in extension. Instruct the patient to actively extend the P.I.P. joint. If the patient is unable to actively extend the P.I.P. joint, an avulsion of the extensor tendon central slip is indicated. This represents a boutonniere deformity, which is characterized by hyperextension of the D.I.P. joint with the P.I.P. joint assuming a position of flexion. You should note that a similar deformity may occur from a pseudo boutonniere deformity which results from a flexion contracture of the P.I.P. due to volar capsule injury. A patient with a pseudo boutonniere deformity will be unable to extend the P.I.P. joint but will retain the ability to flex the D.I.P. joint. (Pause) When performing the boutonniere deformity test ask the patient to flex the D.I.P. joint while you maintain extension of the P.I.P. joint. If the patient cannot extend the P.I.P. joint but can actively flex the D.I.P. joint, a pseudo boutonniere deformity is indicated. [2] 
Assesses central slip integrity of the extensor tendon at the PIP joint.
WRIST