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The Diagnostic Clinical Value of Thumb Metacarpal Grind, Pressure-Shear, Flexion and Extension Tests for Carpometacarpal Osteoarthritis
Yaron Sela, MD; Jodi Seftchick, CHT; Mark E. Baratz, MD
University of Pittsburgh Medical Center, Pittsburgh, PA

Background: Thumb carpometacarpal (CMC) joint osteoarthritis (OA) is a frequent cause of thumb pain associate with functional disability. It is the second most common site of arthritis in the hand, and is considered the most common site requiring surgery for pain relief and increased function. Thumb CMC OA commonly affects post-menopausal females and young male manual laborers. There is limited data on the sensitivity and specificity of the different physical examination tests that attempt to differentiate CMC joint OA from other sources of pain surrounding the base of the thumb and radial side wrist joint.

Purpose of the Study: To compare the diagnostic value of the Grind test, metacarpal Flexion, metacarpal Extension and pressure-shear tests for CMC OA of the thumb and compare these results with the Eaton classification system.

Methods: Radiological evaluation was used as the gold standard. One hundred twenty seven thumbs from 104 patients were included in the study. The grind test, metacarpal flexion, metacarpal extension and Pressure-Shear tests and radiographic evaluation over a 12 month period of time were performed by a certified hand surgeon. The sensitivity, specificity, and predictive values of each test were calculated for the primary outcome of diagnosing thumb CMC OA. In a secondary analysis of cases with thumb CMC OA, polychoric correlation coefficients were used to assess how well each test correlated with severity as defined by Eaton and Littler stage.

Results: The overall diagnostic accuracy of the thumb metacarpal Grind, Pressure-Shear, Flexion, and Extension test were 70%, 98%, 47%, and 55%, respectively, for the primary outcome of diagnosing thumb CMC OA. For the same outcome, the sensitivities (with 95% confidence intervals) of thumb metacarpal Grind, Pressure-Shear, Flexion and Extension tests were 64% (54-73), 99% (95-100), 36 (27-46) and 46% (36-56), respectively. The specificities of thumb metacarpal Grind, Pressure-Shear, Flexion and Extension tests were 100% (78-100), 95% (77-100), 100% (78-100), and 100% (78-100), respectively. For the secondary outcome of thumb CMC arthritis severity, polychoric correlation coefficients for the grind, Pressure-shear, flexion, and extension tests were 0.33, 0.12, 0.25, and 0.36, respectively.

Conclusion: For the diagnosis of thumb CMC OA, the metacarpal Pressure-Shear test was superior overall in terms of diagnostic accuracy and sensitivity, while having comparable specificity to the other tests. The Extension test appeared to correlate most strongly with severity of CMC OA cases.

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