REIDER PART 164
154
Chapter 4_Hand and Wrist
Figurę 4-87. A and B, The distal radioulnar joint compression test.
then arthritis or instability of the distal radioulnar joint is probably prescnt. This maneuver may be callcd the distal radioulnar joint compression test.
Triangular Fibrocartilage Complex Compression Test
If tenderness just distal to the ulnar head has raised the suspicion of injury to the TFCC, the examiner can further investigate this possibility with the TFCC compression test. To perform this test, the patient s forearm is placed in a pronated position with the elbow flexed. To test the right wrist, for example, the examiner’s right hand grasps the patients right hand and the examiner’s left hand sta-bilizes the patients forearm. The wrist is then loaded by compressing the hand proximally against the forearm, and the wrist is moved repeatedly back and forth from radial deviation to ulnar deviation (Fig. 4-88). In the presencc of a symptomatic TFCC tcar, this maneuvcr usually produces painful clicking and popping. Although this test is similar to the midcarpal instability test, the sensation of popping and clicking of the TFCC is very different from the visible jumping or clunking sensation produced by midcarpal instability.
Grind Test
The grind test is a provocative test to elicit symptoms of basilar joint arthritis. To examine the patients right thumb, for example, the examiner grasps the patients right first metacarpal between the thumb, the index fin-ger, and the long finger of the examiner’s right hand. The examiner’s left thumb then pushes down on the dorsum of the base of the first metacarpal. This action has the effect of reducing the basilar joint in case it is subluxed. This reduction maneuver is the first part of the shuck test, as described previously. While maintaining the basilar joint in reduction, the examiner loads the basilar joint by pushing the first metacarpal proximally and then rotating the metacarpal in a circular fashion (Fig. 4-89). This portion of the examination is known as the grind test. If the circumduction maneuver reproduces
Figurę 4-88. A and B, Triangular fibrocartilage complex (TFCC) compression test (arrows indicate the direction of the applied compression force).
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