Fractures and dislocations: Bunnell test for intrinsic tightness: 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 · Fractures and dislocations: Bunnell test for intrinsic tightness

Sample item

In a patient with rheumatoid arthritis, passive flexion of the proximal interphalangeal joint of a finger is limited when the MCP joint is held in extension, but the PIP joint flexes freely when the MCP joint is flexed. What does this show?

ACapsular contracture of the PIP jointBTight intrinsic musclesCTight extrinsic extensor tendonsDAdhesion of flexor digitorum superficialis

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

The answer and the reasoning

B. Tight intrinsic muscles

The intrinsic tightness test (Bunnell) compares PIP motion with the MCP joint extended and flexed. If PIP flexion is limited with the MCP extended and improves with MCP flexion, the intrinsic muscles are tight, because flexing the MCP slackens them. The reverse pattern indicates tight extrinsic extensors, and a fixed limit in both positions indicates a joint contracture.

Option by option

A. Capsular contracture of the PIP joint
A capsular contracture limits PIP flexion in every MCP position.
B. Tight intrinsic muscles (correct)
Correct. Improvement of PIP flexion when the MCP is flexed shows that the intrinsics were tight.
C. Tight extrinsic extensor tendons
Tight extrinsic extensors limit PIP flexion when the MCP is flexed, and release when it is extended.
D. Adhesion of flexor digitorum superficialis
Adhesion of the flexor tendon restricts passive extension rather than flexion.

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.

Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is B, Tight intrinsic muscles. The intrinsic tightness test (Bunnell) compares PIP motion with the MCP joint extended and flexed.

Why is "Capsular contracture of the PIP joint" not the answer?

A capsular contracture limits PIP flexion in every MCP position.

Why is "Tight extrinsic extensor tendons" not the answer?

Tight extrinsic extensors limit PIP flexion when the MCP is flexed, and release when it is extended.

Why is "Adhesion of flexor digitorum superficialis" not the answer?

Adhesion of the flexor tendon restricts passive extension rather than flexion.

What concept does this question test?

It tests Fractures and dislocations: Bunnell test for intrinsic tightness in Orthopaedics. If PIP flexion is limited with the MCP extended and improves with MCP flexion, the intrinsic muscles are tight, because flexing the MCP slackens them. The reverse pattern indicates tight extrinsic extensors, and a fixed limit in both positions indicates a joint contracture.

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 Fractures and dislocations: Bunnell test for intrinsic tightness?

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.