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Kinematics of the scaphoid shift test
S W Wolfe1, A Gupta, J J Crisco
1Yale Hand and Upper Extremity Center, Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT 06520-8071, USA.
The Journal of Hand Surgery
|October 23, 1997
Summary
The scaphoid shift test has limited accuracy in detecting dorsal scaphoid displacement in uninjured wrists. A positive test result in healthy individuals may be due to midcarpal shift, necessitating fluoroscopic confirmation.
Area of Science:
- Orthopedics
- Biomechanics
- Radiology
Background:
- The scaphoid shift test is a clinical maneuver used to assess scaphoid instability.
- Understanding the reliability of this test in asymptomatic individuals is crucial for accurate diagnosis.
Purpose of the Study:
- To evaluate the diagnostic accuracy of the scaphoid shift test in detecting dorsal displacement of the scaphoid bone in uninjured wrists.
- To identify factors that may confound the interpretation of the scaphoid shift test.
Main Methods:
- Clinical and fluoroscopic examinations were performed on 25 uninjured subjects (50 wrists).
- Wrists were categorized based on palpable carpal motion during the scaphoid shift test.
- Kinematic parameters (rotation, displacement) of carpals were calculated from digitized images.
Main Results:
- 36% of asymptomatic individuals exhibited positive scaphoid shift test findings.
- Dorsal scaphoid displacement was not significantly associated with positive test results.
- Total scaphoid displacement (axial + dorsal) showed a significant association with positive test results.
- A 'midcarpal shift' (capitolunate joint displacement) was identified as a confounding factor.
Conclusions:
- The scaphoid shift test has limited ability to accurately detect dorsal scaphoid displacement in healthy individuals.
- A high prevalence of positive results in uninjured subjects suggests potential for false positives.
- Fluoroscopic confirmation is recommended for positive scaphoid shift test findings.