Clinical provocative tests used in evaluating wrist pain: a descriptive study

The purposes of this clinical study were to standardize the method of examination and provocative testing of painful wrists and to compare retrospectively the results of these tests with the arthroscopic findings of three independent hand surgeons. This article operationally defines the scaphoid shift test (SST), the ballottement test (BALLOT), and the ulnomeniscotriquetral dorsal glide test (UMTDG); describes the clinical and arthroscopic examination method; and analyzes the sensitivities, specificities, and predictive values of these provocative tests relative to the arthroscopic findings in 50 painful wrists. Each patient had unspecified wrist pain of at least 4 weeks' duration and was examined by one certified hand therapist who carried out all of the clinical provocative tests. The sensitivities for the SST, the BALLOT, and the UMTDG were 69%, 64%, and 66%, respectively. The specificities for the SST, the BALLOT, and the UMTDG were 66%, 44%, and 64%, respectively. The positive predictive values for the SST, the BALLOT, and the UMTDG were 48%, 24%, and 58%, respectively. The negative predictive values for the SST, the BALLOT, and the UMTDG were 78%, 81%, and 69%, respectively. These wrist provocative tests were efficient for identifying patients who needed a more detailed diagnostic workup and possible arthroscopic inspection. Of those patients who needed arthroscopic inspection, the provocative tests proved to be more efficient at predicting the absence of injury than at predicting its presence.