Nerve injuries: Bouvier test: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Orthopaedics · Nerve injuries: Bouvier test

Sample item

In an ulnar claw hand, the examiner blocks hyperextension of the metacarpophalangeal joints with a finger and the patient can then extend the interphalangeal joints. What does a positive Bouvier test imply?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. The extensor digitorum can extend the IP joints once the MCP joint is stabilised, so the claw is correctable by a lasso-type transfer

In ulnar claw hand the paralysed lumbricals cannot flex the MCP joints, so the extensor digitorum hyperextends them and cannot extend the interphalangeal joints. Blocking MCP hyperextension restores IP extension, which is the Bouvier manoeuvre. A positive test means the claw is flexible and can be corrected by a tendon transfer such as the Zancolli lasso.

Option by option

  • A. The extensor digitorum can extend the IP joints once the MCP joint is stabilised, so the claw is correctable by a lasso-type transfer (correct)

    Correct. A positive Bouvier test shows a correctable claw suitable for tendon transfer.

  • B. The joints are fixed in contracture and require arthrodesis

    A fixed deformity would not correct with blocking.

  • C. The radial nerve is also divided

    The radial nerve supplies the extensor digitorum, which is working in this test.

  • D. The flexor tendons are ruptured

    Tendon rupture is not the cause of ulnar claw and would not correct on blocking.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is A, The extensor digitorum can extend the IP joints once the MCP joint is stabilised, so the claw is correctable by a lasso-type transfer. In ulnar claw hand the paralysed lumbricals cannot flex the MCP joints, so the extensor digitorum hyperextends them and cannot extend the interphalangeal joints.

Why is "The joints are fixed in contracture and require arthrodesis" not the answer?

A fixed deformity would not correct with blocking.

Why is "The radial nerve is also divided" not the answer?

The radial nerve supplies the extensor digitorum, which is working in this test.

Why is "The flexor tendons are ruptured" not the answer?

Tendon rupture is not the cause of ulnar claw and would not correct on blocking.

What concept does this question test?

It tests Nerve injuries: Bouvier test in Orthopaedics. Blocking MCP hyperextension restores IP extension, which is the Bouvier manoeuvre. A positive test means the claw is flexible and can be corrected by a tendon transfer such as the Zancolli lasso.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Nerve injuries: Bouvier test?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.