Wrist & Hand
Muscle & Tendon
Evidence: uncertain
Bunnel-Littler Test Special Test
Orthopedic Physical Examination & Clinical Assessment Guide
What is it used for?
- Differentiating Intrinsic Muscle Tightness from Joint Capsule Tightness.
How to Perform
- Step 1: Extend MCP joint and flex PIP joint.
- Step 2: Flex MCP joint and flex PIP joint.
Interpretation of Results
- Intrinsic Tightness: PIP flexes more when MCP is flexed (relaxes the intrinsics).
- Capsular Tightness: PIP movement is restricted equally in both positions.
Clinical Context & Limitations
The Bunnel-Littler Test should be considered as one component of a comprehensive musculoskeletal assessment. No single special test has perfect diagnostic accuracy; thus, clinical decision-making should integrate test results with patient-reported symptoms, mechanism of injury, functional impairment, and relevant imaging.
Clinicians should be aware of potential false-positive results in patients with pain sensitisation, muscle guarding, or poor relaxation. For the Wrist & Hand region, combining the Bunnel-Littler Test with complementary examination tests significantly improves overall diagnostic confidence.
