Summary Intrinsic Plus Hand is a hand posture characterized by MCP flexion with PIP and DIP extension. caused by imbalance between spastic intrinsics and weak extrinsics muscles of the hand. Diagnosis is made by clinical exam which shows MCP flexion and IP joint extension Treatment may be nonoperative or operative depending on the severity of the contracture and impact on quality of life. Epidemiology Incidence rare < 1 per 100,000 annually Etiology Pathophysiology trauma direct trauma indirect trauma vascular injury compartment syndrome rheumatoid arthritis MCP joint dislocations and ulnar deviation lead to spastic intrinsics neurologic pathology traumatic brain injury cerebral palsy cerebrovascular accident Parkinson's syndrome Pathoanatomy spastic intrinsics leads to flexion of the MCP and extension of the IP joints EDC weakness fails to provide balancing extension force to MCP joint FDS & FDP weakness fail to provide balancing flexion force to PIP and DIP joints Presentation Symptoms difficulty gripping large objects Physical exam inspection MCP joint flexion and IP joint extension provocative tests Bunnell test (intrinsic tightness test) differentiates intrinsic tightness and extrinsic tightness positive test when PIP flexion is less with MCP extension than with MCP flexion Imaging Radiographs no radiographs required in diagnosis or treatment Treatment Nonoperative passive stretching indications mild cases Operative proximal muscle slide indications less severe deformities when there is some remaining function of the intrinsics (e.g., spastic intrinsics) distal instrinsic release (distal to MP) indications more severe deformity involving both MCP and IP joints dysfunctional intrinsic muscles (e.g., fibrotic) Techniques Proximal muscle slide techinque subperiosteal elevation of interossei lengthens muscle-tendon unit Distal intrinsic release technique resection of intrinsic tendon distal to the transverse fibers responsible for MCP joint flexion
QUESTIONS 1 of 3 1 2 3 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ18.120) A 39-year-old construction worker presents to your clinic with a complaint of decreased ability to use his right hand at work. He sustained a crush injury to his hand 7 months ago and reports persistent swelling in the hand for 1-2 months after the injury. A new radiograph is shown in figure A. On physical exam, he can passively flex the proximal interphalangeal (PIP) joint when the metacarpophalangeal (MCP) joint is flexed but not when the MCP joint is extended. Based on this information, where is his stiffness most likely originating from? QID: 213016 FIGURES: A Type & Select Correct Answer 1 PIP joint capsule 2% (33/1834) 2 MCP joint capsule 6% (107/1834) 3 Extrinsic musculature 17% (311/1834) 4 Intrinsic musculature 74% (1362/1834) 5 Bone deformity 0% (3/1834) L 2 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic (OBQ08.238) A 45-year-old carpenter complains of difficult gripping a hammer, which worsens with repeated use. On physical exam, he is able to passively flex the proximal interphalangeal (PIP) joint when the metacarpophalangeal (MCP) joint is flexed but not when the MCP joint is extended. What is the most likely explanation? QID: 624 Type & Select Correct Answer 1 Quadrigia effect 5% (217/4253) 2 Extrinsic tightness 13% (553/4253) 3 Intrinsic tightness 66% (2805/4253) 4 Central slip rupture 8% (345/4253) 5 Lumbrical plus 7% (314/4253) L 3 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic
All Videos (1) Podcasts (1) Login to View Community Videos Login to View Community Videos Bunnell Test for Intrinsic Tightness Mark Karadsheh Hand - Intrinsic Plus Hand C 3/5/2014 16559 views 3.7 (27) HandâȘIntrinsic Plus Hand Hand - Intrinsic Plus Hand Listen Now 6:51 min 9/8/2020 230 plays 0.0 (0)