Boutonnière deformity is an injury to the tendons in your fingers that usually prevents the finger from fully straightening. The result is that the middle joint of the injured finger bends down, while the fingertip bends back. This is the characteristic shape of a boutonnière deformity. Unless this injury is treated promptly, the deformity may progress, resulting in permanent deformity and impaired functioning.

Arthritis affects millions of people in the United States. Often, arthritis strikes at the weightbearing joints of the body, such as the knees and the shoulders. But a significant number of people suffer from arthritis in their wrists and hands that make it difficult for them to perform the activities of daily living.

Although there are hundreds of kinds of arthritis, most wrist pain is caused by just two types:

• Osteoarthritis (OA) is a progressive condition that destroys the smooth articular cartilage covering the ends of bones. The bare bones rub against each other, resulting in pain, stiffness and weakness. OA can develop due to normal “wear-and-tear” on the wrist or as a result of a traumatic injury to the forearm, wrist or ligaments.
• Rheumatoid arthritis (RA) is a systemic inflammatory disease that affects the joint linings and destroys bones, tissues, and joints. Rheumatoid arthritis often starts in smaller joints, like those found in the hand and wrist, and is symmetrical, meaning that it usually affects the same joint on both sides of the body.

Arthritis is a condition that irritates or destroys a joint. Although there are several types of arthritis, the one that most often affects the joint at the base of the thumb (the basal joint) is osteoarthritis (degenerative or “wear-and-tear” arthritis).

Osteoarthritis occurs when the smooth cartilage that covers the ends of the bones begins to wear away. Cartilage enables the bones to glide easily in the joint; without it, bones rub against each other, causing friction and damage to the bones and the joint.

Thumb Arthritis of the thumb base is more common in women than in men, and usually occurs after age 40. Prior fractures or other injuries to the joint may increase the likelihood of developing this condition.

The hand and wrist have multiple small joints that work together to produce motion. This gives you the fine motion needed to thread a needle or tie a shoelace. When the joints become affected with arthritis, activities of daily living can be difficult. Arthritis can occur in multiple areas of the hand and wrist. It can have multiple causes.

All arthritic joints lose cartilage, which works as nature’s “shock absorber.” Cartilage provides a smooth gliding surface for the joint. When the cartilage becomes worn or damaged, or is lost due to disease or trauma, the joint no longer has a painless, mobile area of motion.

The body attempts to make up for the lost cartilage. It produces fluid in the joint lining (synovium), which tries to act like a cushion, like water in a waterbed. But it also causes the joint to swell. This restricts motion. The swelling causes stretching of the joint covering (capsule), which causes pain.

Over time, if the arthritis is not treated, the bones that make up the joint can lose their normal shape. This causes more pain and further limits motion.

Each year millions of people in the United States-most of them children—are bitten by animals. Most animal bites are from dogs; cat bites are second most common. However, the risk of infection from a cat bite is much higher than that from a dog bite. Most bites occur on the fingers of the dominant hand, but children may also be bitten about the head and neck area.

A major concern about an animal bite is the possibility of rabies. Because most pets in the U.S. are vaccinated, most cases of rabies result from the bite of a wild animal such as a skunk, bat or raccoon. However, in other countries, dog bites are the most common source of rabies. If you are bitten by a dog outside the U.S., consult a doctor immediately.
Signs and symptoms

In some cases, the bite will not break the skin but may cause damage to underlying tendons and joints. If the skin is broken, there is the additional possibility of infection as well as injury to tendons and nerves. Dogs have powerful jaws and can cause crushing injuries to bone, muscles, tendons, ligaments and nerves.

Signs of an infection include:

• Warmth around the wound
• Swelling
• Pain
• A pus discharge
• Redness around the puncture wound

Signs of damage to tendons or nerves include:

• An inability to bend or straighten the finger
• A loss of sensation over the tip of the finger

First aid

• Don’t put the bitten area in your mouth! You will just be adding the bacteria in your mouth to that already in the wound.
• If the wound is superficial, wash the area thoroughly. Use soap and water or an antiseptic such as hydrogen peroxide or alcohol. Apply an antibiotic ointment and cover with a non-stick bandage. Watch the area carefully to see if there are signs of damaged nerves or tendons. Some bruising may develop, but the wound should heal within a week to 10 days. If it does not, or if you see signs of infection or damage to nerves and tendons, seek medical help.
• If there is bleeding, apply direct pressure with a clean dry cloth. Elevate the area. Do not clean a wound that is actively bleeding. Cover the wound with a clean sterile dressing and always seek medical help.
• If the wound is to the face and/or head and neck area, seek medical help immediately.
• Contact your physician to see whether additional treatment is needed.
• Report the incident to your public health department. They may ask your assistance in locating the animal so that it can be confined and observed for symptoms of rabies.

Medical assistance
Tell your doctor how you got the bite. Your physician will wash the wound area thoroughly and check for signs of nerve or tendon damage. The doctor may examine your arm to see if there are signs of a spreading infection. Your physician will probably leave the wound open (without stitches), unless you have a facial wound. You may need to get X-rays and a blood test. You may also need to get a tetanus shot and a prescription for antibiotics. If the tendons or nerves have been injured, you may need to see a specialist for additional treatment.

More about rabies
Rabies is a disease that affects only mammals (such as raccoons, bats, dogs, horses, and humans). It is caused by a virus that attacks the nervous system. Without treatment, it is 100 percent fatal. Rabies develops in two stages. During the first stage, which can last up to 10 days, the individual may have a headache, fever, decreased appetite, vomiting and general malaise, along with pain, itching, and tingling at the wound site. Symptoms of stage two include difficulty in swallowing, agitation, disorientation, paralysis, and coma. At this point, there is no known, effective treatment.

If rabies is identified early, a series of highly effective vaccinations can be administered. That’s why it’s important to capture and observe the animal that bit you. If the animal cannot be captured, but must be killed, the head should be kept intact so the brain can be examined for signs of rabies.

Preventing animal bites
Follow these recommendations to prevent animal bites and rabies.

• Do not try to separate fighting animals.
• Avoid animals that appear sick or act strangely. Call animal control.
• Leave animals, even pets or other animals you know, alone when they are eating or sleeping.
• Keep pets on a leash when out in public.
• Never leave a young child alone with a pet. Don’t allow children to tease an animal by waving sticks, throwing stones, or pulling a tail.
• Be sure your pet is vaccinated.
• Do not approach or play with any kind of wild animal. Teach children not to pet strange animals, even pets on a leash, without asking permission of the owner first.