Physical Examination of the Wrist: Useful Provocative Maneuvers

Kleinman, William B.

doi:10.1016/j.jhsa.2015.01.016

Cited by 25 publications

(16 citation statements)

References 23 publications

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“…However, the results of this advanced imaging would not have changed our initial nonsurgical treatment plan. We agree with Kleinman 7,8 that assessment of DRUJ instability should be made on clinical grounds without relying on MRI evaluation. Our experience has been that wrist MRI is not necessary to establish a diagnosis and often may be regarded as a waste of health care resources, as others have observed.…”

Section: Discussionsupporting

confidence: 83%

Nonsurgical Treatment for Acute Posttraumatic Distal Radioulnar Joint Instability: A Case Series

Bachinskas

Helsper

Morris

et al. 2020

Journal of Hand Surgery Global Online

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We investigated the clinical outcomes of patients with acute posttraumatic distal radioulnar joint (DRUJ) instability who were treated with our nonsurgical protocol. Methods: The electronic database of our community-based orthopedic practice was queried to identify patients with posttraumatic wrist pain and DRUJ instability who presented for treatment less than 6 weeks after injury. Medical records review defined a cohort of 16 patients treated between November, 2000 and December, 2016 with immobilization of the wrist and elbow for 6 weeks and gradual return to full activity at 6 months after injury. Data from the medical records were compiled and analyzed to assess short-term outcomes. Eight patients with a minimum 2-year follow-up completed questionnaires and underwent a wrist-focused examination to assess long-term outcomes. We used Wilcoxon signed-ranks exact test and McNemar chi-square exact test to confirm the statistical significance of observed trends in key outcome measures. Results: At a mean long-term follow-up of 6.7 years, there was statistically significant improvement in ulnar-sided wrist pain and all eight subjects examined demonstrated a negative dorsopalmar stress test indicating improved DRUJ stability. Analysis of the entire cohort showed that 11 of 16 patients (69%) were overall improved with respect to wrist pain and DRUJ stability at final follow-up evaluation. Ulnarpositive variance was a relative contraindication to nonsurgical treatment. Conclusions: Prompt above-elbow immobilization of patients with acute posttraumatic DRUJ instability may result in a good clinical outcome without operative treatment. Type of study/level of evidence: Therapeutic IV.

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Section: Discussionsupporting

confidence: 83%

Nonsurgical Treatment for Acute Posttraumatic Distal Radioulnar Joint Instability: A Case Series

Bachinskas

Helsper

Morris

et al. 2020

Journal of Hand Surgery Global Online

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“…Several diseases cause wrist pain, and it is important to distinguish between them [ [15] , [16] , [17] ] before beginning treatment. We must confirm the patient’s medical history, perform a thorough physical examination, and be aware of the repercussions of misdiagnosis.…”

Section: Discussionmentioning

confidence: 99%

Osteoid osteoma of the wrist misdiagnosed as de Quervain’s tenosynovitis due to normal X-ray at the first visit: A case report

Iwatsuki

Yoneda

Kurimoto

et al. 2020

International Journal of Surgery Case Reports

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“…Provocative tests specific to the diagnosis of USWP were performed and recorded. These tests include distal radioulnar joint instability test, 2 midcarpal instability test, 3 lunotriquetral shuck test, 4 ulnar carpal grind test, 5 ulnar foveal sign, extensor carpi ulnaris (ECU) instability test and pisotriquetral shear test 6,7 . The investigations performed for each patient were also recorded.…”

Section: Methodsmentioning

confidence: 99%

Ulnar‐sided wrist pain: a prospective analysis of diagnostic clinical tests

Yang

McCombe

Keating³

et al. 2021

ANZ Journal of Surgery

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Background Identifying the cause of pain on the ulnar side of the wrist can be challenging. The outcome and recovery following surgery can be unpredictable. The aim of this study was to document and analyse the clinical tests used to evaluate the cause of ulnar‐sided wrist pain and determine their diagnostic relevance. Methods This is a prospective evaluation of 110 patients who presented with pain on the ulnar side of the wrist. The clinical evaluation and results from radiological investigations were documented and analysed. Results There were 17 different diagnoses. Eighty‐five percent of the diagnoses were triangular fibrocartilage complex (TFCC) injuries, ulnocarpal abutment syndrome (UCAS), pisotriquetral arthritis (PTA), triquetral fracture or non‐union, distal radioulnar joint arthritis (DRUJ OA) and extensor carpi ulnaris (ECU) pathology. The ulnocarpal stress test and ulnar foveal sign were positive in several diagnoses. The ulnar foveal sign had a sensitivity and specificity of 89% and 48% for TFCC injuries, and 85% and 37% for UCAS, respectively. The sensitivity and specificity of pisotriquetral shear test for PTA was 100% and 92%, respectively. Patients with PTA or ECU pathology localised their pain better on the patient's pain localisation chart. Conclusion Diagnosis of TFCC injuries, UCAS, DRUJ OA and ECU injuries are challenging as the clinical symptoms and signs for the four diagnoses were similar and required either magnetic resonance imaging or computed tomography for diagnostic confirmation after clinical examination. The ulnocarpal stress test and the ulnar foveal sign were not sufficiently specific.

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Physical Examination of the Wrist: Useful Provocative Maneuvers

Cited by 25 publications

References 23 publications

Nonsurgical Treatment for Acute Posttraumatic Distal Radioulnar Joint Instability: A Case Series

Nonsurgical Treatment for Acute Posttraumatic Distal Radioulnar Joint Instability: A Case Series

Osteoid osteoma of the wrist misdiagnosed as de Quervain’s tenosynovitis due to normal X-ray at the first visit: A case report

Ulnar‐sided wrist pain: a prospective analysis of diagnostic clinical tests

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