Clinical tests in the diagnosis of scapholunate ligament injuries

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Abstract

BACKGROUND: Non-invasive instrumental methods of scapholunate ligament injuries, one of the main wrist joint stabilisers, are complicated by frequent false results of examination, and therefore clinical testing is essential in making the diagnosis. At the same time, the limited number of existing specific tests requires evaluation of their prognostic accuracy.

AIM: Evaluating the diagnostic significance of alternative specific tests in the diagnosis of scapholunate ligament injuries.

MATERIALS AND METHODS: In this study, we performed clinical examination and testing of both carpal joints in 50 subjects who had no complaints of carpal joint dysfunction or pain and denied a history of trauma. In clinical testing, the presence or absence of pain during palpation in the projection of the scapholunate ligament was analysed, as well as the specific Watson test, the navicular balloting test and the Kleinman test, for which specificity was assessed.

RESULTS: The specificity of scapholunate ligament palpation as a diagnostic test was 84.0%, Watson test — 96.0%, navicular balloting test — 98.0%, Kleinman test — 87.0%. The overall specificity of clinical tests was 79.0%. A combination of Watson test, navicular balloting test and Kleinman test achieved the highest specificity (86.0%).

CONCLUSIONS: Clinical testing is an important diagnostic tool in suspected scapholunate ligament injuries, however the benefit of isolated clinical tests is not absolute and therefore the best algorithm for clinical examination of the wrist joint may be the use of several specific clinical tests in combination.

About the authors

Igor O. Golubev

Priorov National Medical Research Center of Traumatology and Orthopedics

Email: iog305@mail.ru
ORCID iD: 0000-0003-2568-7307
SPIN-code: 2090-0471

MD, Dr. Sci. (Med.), Professor

Russian Federation, Moscow

Bella M. Gazimieva

Peoples’ Friendship University of Russia; European Medical Center

Author for correspondence.
Email: bellagazimieva@gmail.com
ORCID iD: 0000-0002-0700-6355
SPIN-code: 4836-9231
Russian Federation, Moscow; Moscow

Maksim E. Sautin

European Medical Center

Email: msautin@emcmos.ru
ORCID iD: 0000-0001-9933-7102
SPIN-code: 4152-4596

MD, Cand. Sci. (Med.)

Russian Federation, Moscow

Andrey V. Korolev

Peoples’ Friendship University of Russia; European Medical Center

Email: akorolev@emcmos.ru
ORCID iD: 0000-0002-8769-9963
SPIN-code: 6980-6109

MD, Dr. Sci. (Med.), Professor

Russian Federation, Moscow; Moscow

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Supplementary files

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2. Fig. 1. Watson test: radial deviation of the hand with constant pressure on the distal pole of the scaphoid

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3. Fig. 2. Watson test: dorsal subluxation of the scaphoid with pressure on the distal pole and elimination of displacement with pressure released

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4. Fig. 3. Scaphoid ballottement test: stabilization of the lunate with the fingers of one hand and displacement of the scaphoid dorsally and palmarly relative to the lunate

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5. Fig. 4. Scaphoid ballottement test: displacement of the scaphoid dorsally and palmarly relative to the lunate

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6. Fig. 5. Kleinman test: flexion of the hand with extension of the fingers

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7. Fig. 6. Kleinman test: interposition of the capitate with pressure on the scapholunate joint

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