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The Reduction Maneuver is More Accurate than the Grind or Shift Tests for Diagnosing Thumb Basal Joint Arthritis
Brian A. Mailey, MD; Ashley Ignatiuk, MD; Jennifer Kargel, MD; Dennis Kao, MD; Douglas Sammer, MD; Jonathan Cheng, MD
University of Texas Southwestern, Dallas, TX

Background: Physical examination remains essential to establishing most diagnoses in hand surgery. We sought to compare the accuracy of the three most common provocative tests – grind test, shift test, and reduction maneuver – when examining patients for thumb basal joint arthritis.
Methods: Patients evaluated by a single provider for symptomatic thumb basal joint arthritis from 2011-2015 were identified from an institutional database. Charts were reviewed for results of provocative tests (grind, shift, reduction) and classified as positive if they elicited pain. Five surgeons blindly scored radiographs, and the median Eaton stage for each hand was used for comparison. Tests were also performed on asymptomatic control subjects. McNemar’s test was calculated for each provocative test; Cohen’s kappa was used to define the agreement between each test and the diagnosis of thumb basal joint arthritis.
Results: Thirty-seven patients (48 thumbs) were identified in the experimental group. The median Eaton stage was 3. Grind, shift, and reduction were positive in 29%, 27% and 81% of subjects (p<0.001). Sensitivity, specificity, positive predictive value and negative predictive value were higher for reduction (100%, 63%, 82%, 100%) compared to grind (93%, 30%, 33%, 92%) and shift (92%, 29%, 29%, 92%). Each test was separately evaluated for accuracy in diagnosing thumb basal joint arthritis (Table 1.). Grind, shift, and reduction were positive more often in patients with arthritis than in control subjects (McNemar’s p<0.001, p<0.001, and p=0.004, respectively). There was a poor level of agreement for having arthritis and a positive grind or shift (k=0.103, p=0.13 and k=0.095, p=0.16, respectively), but a substantial level of agreement for reduction (k=0.634, p<0.001). There was a 100% correlation between obtaining a positive shift or grind and a positive reduction (p<0.001 and p<0.001, respectively), indicating that if the grind or shift is positive the reductionwill also be positive.
Conclusion: The reduction maneuver is a more accurate test for diagnosing thumb basal joint arthritis than the grind or shift test. Grind or shift are more likely to be positive in higher stages of arthritis, but do not reliably make the correct diagnosis. Reduction was highly accurate regardless of stage. Reduction was appropriately positive in every case in which grind or shift also elicited pain.

Table 1. Comparison of positive tests by stage

  Percentage of Positive Exam by Arthritis Stage
Grind Test 0% 20% 33% 50%
Shift Test 0% 33% 20% 41%
Reduction Maneuver 100% 70% 86% 92%

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