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Bouvier's Maneuver

Exams and Signs

Historical Overview

  • Bouvier’s maneuver was first described by Sauveur Bouvier, an orthopaedic physician in the 19th century.1

Description

  • Bouvier’s maneuver is used to assess function of the central slip of the extrinsic extensor.2
  • Bouvier’s maneuver evaluates the patient’s capacity to extend the interphalangeal (IP) joint with the metacarpophalangeal (MP) joints flexed. It also demonstrates the significance of preventing MP joint hyperextension.3 It helps to verify that clawing of the ring and small fingers is caused by ulnar intrinsic denervation, leading to flexible MP hyperextension and IP joint flexion posturing. This is due to an imbalance between the innervated extrinsic muscles and the denervated ulnar intrinsic muscles of the hand.

Pathophysiology

  • Low ulnar nerve palsy may arise from traumatic injury. Ulnar nerve palsy impedes the muscle balance essential for effective pinch and causes flexible clawing of the ring and little fingers.3
  • Ulnar nerve injuries may result in a claw deformity.4
  • A claw deformity may also occur when the intrinsic muscles of a finger are paralyzed but the joints are flexible.5

Instructions

  1. Obtain an accurate and complete patient history.4
  2. Ask the patient to extend the IP joint with the MP joints flexed.
  3. Check if the MP joints are hyperextended.
  4. Examine the contralateral hand for comparison.

Variations

  • Check the circumduction of the thumb.5

Related Signs and Tests

  • Muscle testing
  • Froment’s sign

Diagnostic Performance Characteristics

  • Bouvier’s maneuver is often used in conjunction with other physical tests during examination of the hand, to confirm the absence of ulnar intrinsic regular function.
Presentation Photos and Related Diagrams
  • Bouvier's Maneuver
    Bouvier's Maneuver
Definition of Positive Result
  • A positive result occurs when the patient is able to extend the IP joint with the MP joint is flexed.
Definition of Negative Result
  • A negative result occurs when the patient is not able to extend the IP joint when the MP joint is flexed.
Comments and Pearls
  • In some cases of ulnar palsy or claw deformity, the central slip may be attenuated and active IP extension may be impossible.  The Bouvier Manuever is, therefore, negative.2 
  • Over time, with a claw deformity, the central slip stretches, the lateral bands translate palmarly and the volar plate contracts. This may result in a fixed deformity.3
  • Problems that cause flexion deformities of the ring and little fingers, such as Dupuytren’s disease, will have irregularities that are not corrected by Bouvier’s maneuver. 
Videos
Intrinsic minus index and slight intrinsic minus long finger after palmer and web laceration. Note positive Bouvier's maneuver at end of video.
References
  1. Monet J, Quin G. Sauveur-Henri-Victor Bouvier (1799-1877): orthopaedist, surgeon and promoter of physical education [French].Gesnerus 2013;70(1):53-67. PMID: 24308261
  2. Kenney RJ, Hammert WC. Physical Examination of the Hand. J Hand Surg Am 2014;39(11):2324-34. PMID: 25442747
  3. Goldfarb CA, Stern PJ. Low Ulnar Nerve Palsy. J Hand Surg Am 2003;3(1):14-26.
  4. Culp R, Jacoby S.  Musculoskeletal Examination of the Elbow, Wrist and Hand: Making the Complex Simple.  New Jersey: SLACK Incorporated, 2012.
  5. Revol M. Principles of palliative motor surgery of paralysis of the hand. Ann Chir Plast Esthet 1993;38(2):210-7 [French]. PMID: 8304744
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