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Published on: January 28, 2010
Clinical provocative tests used in evaluating wrist pain: a descriptive study
1Department of Physical Therapy, College of Health Related Professions, University of Florida, Gainesville 32610-0154, USA.
Summary
This study evaluated wrist provocative tests for painful wrists, finding they are better at ruling out injury than confirming it. These tests help identify patients needing further diagnostic workup.
Area of Science:
- Orthopedics
- Hand Surgery
- Diagnostic Imaging
Background:
- Wrist pain is a common complaint requiring accurate diagnosis.
- Provocative tests are frequently used in clinical examination for wrist conditions.
- Standardization and validation of these tests are crucial for reliable clinical assessment.
Purpose of the Study:
- To standardize examination and provocative testing methods for painful wrists.
- To compare the results of specific provocative tests with arthroscopic findings.
- To analyze the diagnostic accuracy (sensitivity, specificity, predictive values) of these tests.
Main Methods:
- Operational definition of the scaphoid shift test (SST), ballottement test (BALLOT), and ulnomeniscotriquetral dorsal glide test (UMTDG).
- Description of clinical and arthroscopic examination procedures.
- Retrospective analysis of data from 50 patients with painful wrists.
Main Results:
- Sensitivities: SST (69%), BALLOT (64%), UMTDG (66%).
- Specificities: SST (66%), BALLOT (44%), UMTDG (64%).
- Negative predictive values were generally higher than positive predictive values, indicating better ability to rule out injury.
Conclusions:
- Provocative wrist tests are efficient in identifying patients requiring further diagnostic evaluation.
- These tests are more effective at predicting the absence of wrist injury than its presence.
- Further investigation and arthroscopic inspection are recommended for definitive diagnosis in select cases.
