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A boutonnière deformity that is being treated nonsurgically. To maintain the maximum amount of hand function, which exercise should be performed?

Flexion of the DIP joint with the PIP joint supported in extension

Boutonnière deformity happens when the central slip of the extensor tendon is injured, so the PIP joint tends to stay flexed while the DIP tends to extend. When treated nonoperatively, the PIP is kept in extension to protect the healing central slip, while you still want to keep motion in the other joints to maintain function.

Flexing the DIP while the PIP is held in extension allows the finger to move and preserves tendon glide at the DIP without bending the PIP. This maintains the ability to grip and perform finger tasks as healing occurs. Extending the DIP or flexing the PIP would either stress the injured area or promote positions that don’t help maintain overall hand function during recovery.

Extension of the DIP joint with the PIP joint supported in extension

Flexion of the PIP joint with the DIP joint supported in flexion

Flexion of the PIP joint with the DIP joint supported in extension