A 30-year-old man has cubital tunnel syndrome with clawing of the ring and little fingers. On examination, there is loss of the first web space bulk (first dorsal interosseous wasting), positive Froment's sign, and sensory loss over the medial one and a half fingers. Which test specifically demonstrates the inability to extend the ring and little finger PIP joints when MCP joints are held extended (Bouvier's test negative)?

• A Intrinsic tightness test (Bunnell test)
• B Card test (Egawa's test) for interosseous function
• C Wartenberg sign
• D Bouvier's manoeuvre testing for pseudo-clawing correction ✓

Explanation

Bouvier's manoeuvre assesses whether passive MCP flexion (blocking hyperextension) corrects the IP joint clawing. If passively correcting the MCP hyperextension also corrects the IP flexion deformity (Bouvier's positive), the flexor digitorum superficialis and profundus are intact and a simple MCP blocking splint or intrinsic substitution by lasso procedure suffices. If Bouvier's is negative (IP joints still flexed despite corrected MCP), FDS/FDP dysfunction or joint contracture is present and a more complex reconstruction is needed. Intrinsic tightness test assesses tightness of intrinsics; Card test tests abduction; Wartenberg sign is persistent abduction of the little finger.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.