Validation of a New Clinical Test for Diagnosis of Trapeziometacarpal Arthritis

Symptomatic trapeziometacarpal arthrosis is primarily diagnosed on clinical grounds. The X-ray appearance correlates poorly with the presence and severity of pain; therefore, radiography is not a useful tool to define which patient is symptomatic, nor which one should be treated. There is not a specific gold standard test. The grind test is the most used clinical test; however, its level of diagnostic accuracy is not very high. The aim of this study is to describe and validate a new clinical test.

A prospective study was conducted to evaluate the diagnostic performance and reliability of the compression and flexion test.

A total of 106 patients were included. Excellent interobserver agreement was found for both semiology tests (kappa = 0.82 and intraclass correlation coefficient = 0.97). The area under the curve for the compression and flexion test showed an estimate of 99.2 (95% confidence interval [CI]: 97.6-100) and for the grind test of 62 (95% CI: 51.2-71.9). The diagnostic performance of the compression and flexion test showed a sensitivity of 100% (95% CI: 92.1-99.9) and a specificity of 98.4% (95% CI: 91.2-100), in contrast to the grind test that reports a sensitivity of 22.2% (95% CI: 11.2-37.1) and a specificity of 93.4% [95% CI: 84.1-98.2].

The diagnostic performance of the compression and flexion test is higher than that of the grind test. Furthermore, the results show an excellent interobserver correlation and diagnostic accuracy, making it a useful clinical tool for the diagnosis of trapeziometacarpal arthritis.

Diagnostic tests II.