Intrinsic Plus Hand

  • Intrinsic tightness following a severe crush injury to the hand or unrecognized compartment syndrome or trauma or distal joint malalignment due to RA
  • Physical examination:  limited PIP flexion while the MP joints are fully extended, with greater PIP flexion with the MP joints flexed.
  • Bunnell test=MCP hyperextension puts intrinsics on stretch and causes decreased IP flexion with intrinsic tightness. This is due to the displacement of the lateral bands which occurs due to many reasons.
  • MCP joint flexion and IP extension resting posture.
  • RX passive stretching
  • surgery=loosening intrinsics by distal release or proximal muscle slide resection of the lateral bands and oblique fibers.


  • Smith RJ: Non-ischemic contractures of the intrinsic muscles of the hand. JBJS 1971;53:1313-1331
  • BUNNELL S. Ischaemic contracture, local, in the hand. J Bone Joint Surg Am. 1953 Jan;35-A(1):88-101.
  • HARRIS C Jr, RIORDAN DC. Intrinsic contracture in the hand and its surgical treatment. J Bone Joint Surg Am. 1954 Jan;36-A(1):10-20.