Flexion of the proximal interphalangeal joint and hyperextension of the Distal Interphalangeal joint are seen… - DSSSB October 2024

DSSSB October 2024

Medical & Surgical Nursing

Easy

Appeared in: DSSSB October 2024

Explanation

Boutonniere deformity is characterized by a specific pattern: flexion of the proximal interphalangeal (PIP) joint and hyperextension of the distal interphalangeal (DIP) joint.
This deformity is typically caused by damage to the central slip of the extensor tendon over the PIP joint.
The damage allows the PIP joint to flex, and the subsequent imbalance in tendon forces causes the DIP joint to hyperextend.
It is a classic sign often associated with rheumatoid arthritis but can also result from direct injury to the finger.

Option A: Heberden's nodes are hard, bony swellings that form on the distal interphalangeal (DIP) joints. They are a sign of osteoarthritis and represent bony hypertrophy, not a flexion/hyperextension deformity.
Option C: Swan neck deformity is the opposite of Boutonniere deformity. It involves hyperextension of the PIP joint and flexion of the DIP joint.
Option D: Bouchard's nodes are bony swellings on the proximal interphalangeal (PIP) joints. Like Heberden's nodes, they are a characteristic feature of osteoarthritis, not a description of joint flexion and extension.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Identification of hand deformities based on joint position as background academic context rather than a clinical decision trigger.
Recognizing these deformities is crucial for nurses as it helps in identifying the underlying disease (e.g., Rheumatoid Arthritis vs. Osteoarthritis) and assessing disease progression.
Early identification allows for timely intervention with splinting, therapy, and patient education to preserve hand function and manage symptoms.
What if the patient presented with hyperextension of the PIP joint and flexion of the DIP joint? The diagnosis would be Swan neck deformity, which also requires specific management strategies to improve function and reduce pain.

How to Approach the Question

First, break down the question stem to identify the key clinical signs: flexion of the PIP joint and hyperextension of the DIP joint.
Next, recall the definitions of the four hand conditions listed in the options.
Systematically compare the signs described in the stem with the definition of each option.
Eliminate 'Heberden's nodes' and 'Bouchard's nodes' as they describe bony growths (signs of osteoarthritis), not the specific joint postures described.
Differentiate between 'Boutonniere deformity' and 'Swan neck deformity'. Recognize that Swan neck deformity is the opposite of what is described.
Conclude that the combination of PIP flexion and DIP hyperextension perfectly matches the definition of Boutonniere deformity.

Concept Tested & Keywords

Concept Tested: Identification of hand deformities based on joint position.
Stem keywords: Flexion, proximal interphalangeal joint, hyperextension, Distal Interphalangeal joint
Lead-in keywords: seen in
Negative lead-in flag: false

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E6 Medicine Macleod Clinical Examination 15e pp. 308-310, 307-309

E6 Medicine Harrison 22e Part 2 p. 847-849