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Intrinsic Tightness and the Intrinsic Plus Hand

- See:
    - Intrinsic Muscles:

- Discussion:
    - results from intrisic stiffness (contracture);
    - specific causes:
           - truama:
               - posttraumatic intrinsic contractures may occur after severe injuries to hand that have resulted in considerable 
                      edema or hematoma;
           - ischemia
           - rheumatoid arthritis
           - Still's disease
           - mycobacterium leprae
           - CNS lesions
           - Parkinson's disease
           - cerebral palsy

- Exam:
    - Bunnel test:
    - early intrinsic extensor tightness of the PIP joint;
           - stiffness, tightness of fingers on grasp;
           - full flexion possible when MCP fully flexed;

- Treatment:
    - corrected with therapy, or if that fails, sometimes by intrinsic release/transfer (Little - distal) or (Zancolli - proximal);
    - late deformity:
            - distal intrinsiic releae of those oblique fibers contributing to lateral bands, preserving more proximal transverse contribution 
                   of interosseous aponeurotic expansion