Bunnell-Littler Test

Original Editor - Jon DeVaul, PT, DPT

Contents

Purpose

Image courtesy of Primal Pictures
Image courtesy of Primal Pictures

This test evaluates the source of PIP flexion motion limitation by differentiating between intrinsic muscle or capsular tightness in the affected digit.  A typical patient presentation may include pain located in the distal intermetacarpal space and with prolonged gripping or making a fist.  Symptoms are most often seen in the ring and long finger.[1]

Technique

The MCP is held in an extended position and the therapist passively flexes the PIP making note of the available range.  The test is then repeated with the MCP flexed. If no change in motion is detected between the two tests, then capsular restriction at the PIP joint is implicated.  If the motion increases when the MCP is flexed, then lumbricale muscle tightness is implicated.[2]

Positive test finding for PIP restriction
Positive test finding for PIP restriction
Increased PIP flexion with MCP flexion implies intrinsic restriction
Increased PIP flexion with MCP flexion implies intrinsic restriction
No increase in PIP flexion with MCP flexion implies capsular restriction
No increase in PIP flexion with MCP flexion implies capsular restriction
Full PIP flexion with MCP extension is a normal (negative) test finding
Full PIP flexion with MCP extension is a normal (negative) test finding

Evidence

While referred to in many searched texts and articles, no search of Pubmed, Medline, or Medscape produced results pertaining to the specificity or sensitivity of this test by the name Bunnell-Littler, or the associated name Finochietto-Bunnell test. 

Resources

Orthopaedic Physical Therapy by Donatelli and Wooden. 4th edition.

Special Tests for Orthopedic Examination by Konin, Wiksten, Isear, and Brader.  2nd edition.

References


  1. Donatelli RA, Wooden MJ editors:Orthopaedic Physical Therapy, ed 4, St Louis, 2010, Churchill Livingston.
  2. Konin JG, Wiksten DL, Isear Jr., JA, Brader H. Special Tests for Orthopedic Examination, ed 2,Thorofare NJ, 2002, SLACK.

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