Bunnel-Littler Test: How to Check for Hand Intrinsic Tightness

The Bunnel-Littler Test is a key diagnostic test for the hand, used by physiotherapists to differentiate between tightness in the intrinsic muscles (lumbricals/interossei) and tightness in the MCP joint capsule.

1. Purpose

The primary purpose is to differentiate between tightness in the hand's intrinsic muscles (lumbricals and interossei) and tightness (contracture) of the Metacarpophalangeal (MCP) joint capsule. It checks why the Proximal Interphalangeal (PIP) joint cannot flex.

2. How to Perform

1. The patient is positioned in sitting.
2. The examiner isolates the finger being tested.

Part 1 (Test Capsule)

1. The examiner holds the patient's MCP joint in slight extension.
2. The examiner passively flexes the PIP joint and notes the range of motion.

Part 2 (Test Intrinsics)

1. The examiner moves the MCP joint into slight flexion (placing intrinsics on slack).
2. The examiner again passively flexes the PIP joint and notes the range.

3. Positive & Negative Sign

Positive Sign (Test is POSITIVE):
A positive test (indicating an issue) is one of the following:

• Positive for Intrinsic Tightness: PIP joint flexion is limited when the MCP is extended, but full when the MCP is flexed.
• Positive for Capsular Tightness: PIP joint flexion is limited in BOTH MCP extension and MCP flexion.

Negative Sign (Test is NEGATIVE):
A negative test is when full and painless PIP joint flexion is possible in both MCP positions.