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- 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.
References:
- 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.
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