Bunnel-Littler PIP Joint Test on Physical Exam

For intrinsic vs joint capsule cause of restriction or tightness in the PIP joint preventing full flexion - start with unaffected side and compare

1) Extend finger at MCP joint & passively flex finger at PIP

2) Flex MCP & passively flex at the PIP, compare

3) If PIP flexion is limited in MCP extension=intrinsic muscles tightness or joint capsule tightness

4) If tightness is STILL prsents when MCP Flexed, likely due joint capsule

5) If tight PIPJ in MCP extension, but not w/MCP flexion, then likely due to tight intrinsic muscles

(Also, a lot easier to do with both hands, but 🤳🏽)



- Lil Bone Peep @peds_sports_med



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