REIDER PART 162
152 Chaptkr 4__l land and Wrist
Figurę 4-82. A-B, Scaphoid shift test.
proximal pole of the scaphoid subluxing over the dorsal rim of the distal radius. The examiner’s thumb then rcleascs its pressurc from the scaphoid tuberclc, allowing the scaphoid to pop back into the joint (Fig. 4-82C). If this sequence reproduces the patients pain and the pain is relieved when the pressurc on the scaphoid is released, further evidence of scapholunate instability is prcsent.
The scaphoid shuck test was developed as another means to test for scapholunate instability. The test is per-formed with the patienfs elbow flexed and the forearm pronated. The goal of the test is to control the scaphoid and lunate independently and test for abnormal motion of these bones in relation to each othcr. To test the right wrist, the paticnt s right scaphoid is held between the thumb and index finger of the examiner’s right hand and the lunate between the thumb and index finger of the examiner’s left hand. The examiner then moves the scaphoid and the lunate up and down in opposite directions. There should
Figure 4-83. Scaphoid shuck test.
be minimal motion and pain in the normal State. With a complete tcar of the scapholunate ligament, there is signif-icant motion and pain (Fig. 4-83)
The lunotriquetral ballottement test was developed to dctect instability of the lunotriąuetral joint caused by injury. This test is performcd with the patients elbow flexed and forearm pronated. The goal of the test is to control the lunate and triquetrum separately so that they can be moved in relation to each other. To test the patients right hand, for example, the examiner’s left hand grasps the patient s right wrist with the examiner>s left thumb over the triquetrum and the cxaminer s left index finger on the volar surface of the pisiform. The examiner s right hand then grasps the wrist from the othcr side, the exam-iner s right thumb being placed over the dorsum of the patients lunate and the examiner s right index finger over the volar surface of the carpal tunnel. The examiner then attempts to displace the lunate and triquetrum in relation to each other (Fig. 4-84). To do this, the examiner s right hand pidls upward whilc the examincrs left hand pushes downward. This process is then reversed, pushing down-
Figurę 4-84. Lunotriąuetral ballottement test.
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