Abstract
Purpose Symptomatic trapeziometacarpal arthrosis is primarily diagnosed on clinical grounds.
The X-ray appearance correlates poorly with the presence and severity of pain; therefore,
radiography is not a useful tool to define which patient is symptomatic, nor which
one should be treated. There is not a specific gold standard test. The grind test
is the most used clinical test; however, its level of diagnostic accuracy is not very
high. The aim of this study is to describe and validate a new clinical test.
Materials and Methods A prospective study was conducted to evaluate the diagnostic performance and reliability
of the compression and flexion test.
Results A total of 106 patients were included. Excellent interobserver agreement was found
for both semiology tests (kappa = 0.82 and intraclass correlation coefficient = 0.97).
The area under the curve for the compression and flexion test showed an estimate of
99.2 (95% confidence interval [CI]: 97.6–100) and for the grind test of 62 (95% CI:
51.2–71.9). The diagnostic performance of the compression and flexion test showed
a sensitivity of 100% (95% CI: 92.1–99.9) and a specificity of 98.4% (95% CI: 91.2–100),
in contrast to the grind test that reports a sensitivity of 22.2% (95% CI: 11.2–37.1)
and a specificity of 93.4% [95% CI: 84.1–98.2].
Conclusions The diagnostic performance of the compression and flexion test is higher than that
of the grind test. Furthermore, the results show an excellent interobserver correlation
and diagnostic accuracy, making it a useful clinical tool for the diagnosis of trapeziometacarpal
arthritis.
Type of Study/Level of Evidence Diagnostic tests II.
Keywords
rhizarthrosis - thumb - arthrosis of the thumb - thumb base arthrosis - grind test
- compression and flexion test - trapeziometacarpal joint - physical exam - diagnostic
test
