Evaluation of Physical Examination Tests for Thumb Basal Joint Osteoarthritis

Abstract

Background:We compare the ability of 3 diagnostic tests to reproduce the pain of basilar joint arthritis (BJA): the grind test, the lever test (grasping the first metacarpal just distal to the basal joint and shucking back and forth in radial and ulnar directions), and the metacarpophalangeal extension test. Methods: Sixty-two patients with thumb BJA were enrolled. The 3 tests were performed in a random order on both hands of each patient. Prior to testing, patients reported their typical pain level and subsequently rated their pain after each test on a 0 to 10 scale, also specifying the extent to which the test reproduced their thumb pain (fully, partially, not at all). All patients had radiographs that displayed basal joint arthritis. A test was defined as positive for BJA if pain produced was greater than 0. Sensitivity and specificity for each test were calculated using the patients' history of pain localized to the basal joint and BJA diagnosis on radiographs as the gold standard. Results:The lever test produced the greatest level of pain and best reproduced the presenting pain. The lever test also had the highest sensitivity, high specificity, and the lowest false-negative rate. The grind test had the lowest sensitivity, highest specificity, and highest false-negative rate. Conclusions: The lever test was the diagnostic test that best reproduced the pain caused by thumb basal joint osteoarthritis. We recommend using the lever physical examination test when evaluating the patient with suspected basal joint osteoarthritis. The often-quoted grind test is of limited diagnostic value.

Early Cup Loosening After Metal-on-Metal Total Joint Replacement of the Trapeziometacarpal Joint: A Retrieval Study

“…The "grind test" is one such test frequently mentioned in text-books; the examiner holds the painful thumb with one hand and supports the patients wrist and hand with the other hand as compressive and rotatory forces are applied to the thumb along the axis of the metacarpal bone. Recently, two publications suggest that other clinical tests may be more sensitive for the condition (Mailey et al, 2019;Model et al, 2016). Two tests recommended by these papers are the "lever test" and the "relocation test".…”

Development and Validation of a Disease-Specific Questionnaire for Basal Joint Arthritis

“…The diagnosis was based on clinical information, plain radiographs, and physical tests including: the grind test, the lever test, and the metacarpophalangeal extension test. 24 Exclusion criteria included previous enrollment in a BJA registry coordinated by the two affiliated hospitals, age under 18 years, lack of English fluency, current or history of infection of the basal joint, or current active treatment for BJA with no management change. The study received approval from our institutional review board and was funded in part by the Orthopedic Science and Research Foundation.…”

Mobile technology and cumulative trauma symptomology among millennials

“…Information related to CTD symptomology was obtained through orthopedic special tests including: Wright's test, 17 elbow flexion test, 18 Maudsley's test, medial epicondylitis test, Phalen's test, 19 Finkelstein's test, 20 and Lever test. 21 These orthopedic special tests were chosen based on clinical relevance, sensitivity, and specificity. Table 2 gives a description of individual special test technique and psychometric properties.…”