Understanding the Bunnell-Littler Test (or Finochietto-Bunnell Test) Assessment
To differentiate between **Intrinsic Muscle tightness** (interossei and lumbricals) and **Capsular restriction** at the proximal interphalangeal (PIP) joint.
Watch How It's Done
How do I start?
Patient is sitting. The PIP joint to be tested is held in extension.
What happens?
**Phase 1 (Intrinsic Tightness):** The metacarpophalangeal (MCP) joint is held in **extension** while the examiner attempts to passively flex the PIP joint. **Phase 2 (Capsular/Control):** The MCP joint is then held in **slight flexion** while the examiner attempts to passively flex the PIP joint again.
In Plain English
What Does a Positive Result Mean?
If PIP flexion is **increased** when the MCP is flexed (Phase 2), the cause is **Intrinsic Muscle Tightness**. If PIP flexion **remains restricted** in both positions, the cause is **Capsular Restriction**.
Helpful Tip:
Flexing the MCP joint relaxes the intrinsic muscles; if motion improves, the muscles are the problem.
Safety First
This guide is to help you understand what happens in a clinic. Do not try to diagnose yourself. If you have severe pain, swelling, or cannot put weight on your leg, please visit an urgent care center or your doctor immediately.
Other Wrist/Hand Tests
Beighton Score
To quantify **generalized joint hypermobility** (laxity) across the body. The wrist/hand components assess passive joint laxity.
De Quervain's Tenosynovitis
This is the **condition name** (inflammation of the APL and EPB tendons), not a specific test. The Finkelstein Test is the primary diagnostic test.
Elson Test
To assess the integrity of the **Central Slip** of the Extensor Digitorum Communis (EDC) tendon, rupture of which leads to a Boutonniere deformity.
Figure of Eight Measurement of the Hand
To quantitatively measure and track **hand and wrist edema (swelling)** over time, often used post-injury or post-surgery.