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== Purpose   ==
== Search Strategy  ==
 
search engines: PubMed, Science Direct, Web of Knowledge and Google
 
keywords: scaphoid shift test, wrist pain, os scaphoid and wrist.
 
== Purpose<br>  ==
 
The scaphoid shift test is a provocative manoeuvre used to examine the dynamic stability of the scaphoid and reproduce a patient's symptoms. The test is found helpful during the examination of the wrist and more specifically the scaphoid. Beside the stability the examiner will also be able to reflect the quality of the adjoining articular surfaces. (1,3)<br>


The scaphoid shift test is a provocative maneuver used to examine the dynamic stability of the scaphoid and reproduce a patient's symptoms. It is used to diagnose scapholunate interosseous ligament instability (SLIL).<ref name=":6">Kitay A, Wolfe SW. Scapholunate instability: current concepts in diagnosis and management. ''J Hand Surg Am'' 2012;37(10):2175-96.</ref> Watson first described the test to the ''American Research in General Orthopedics'' conference in New Orleans in March 1978. The test is found helpful during the examination of the wrist and more specifically the scaphoid. Beside the stability, the examiner will also be able to reflect the quality of the adjoining articular surfaces.<ref name=":0">H. Kirk Watson, et al.; 1988; Examination of the scaphoid; Journal of Hand Surgery, volume: 13A, 657-60. evidence level: F
</ref><ref name=":2">Kenneth J. Easterling, et al.; 1994; Scaphoid Shift in the Uninjured Wrist; Journal of Hand Surgery, volume: 19A, 604-606 evidence level: C</ref><br>
== Clinically Relevant Anatomy  ==
== Clinically Relevant Anatomy  ==


The ligaments that are thought to provide the principle support to the scaphoid are the radioscaphocapitate ligament, the scaphoid-trapezoid-trapezium ligament and the scapholunate interosseous ligament. (7)<br>
The ligaments that are thought to provide the principle support to the [[scaphoid]] are the radioscaphocapitate ligament, the scaphoid-trapezoid-trapezium ligament and the scapholunate interosseous ligament. <ref name=":1">Wozasek GE, Laske H; 1991; The ligaments of the scaphoid bone; Handchir Mikrochir Plast Chir. Volume 23(1):18-22 evidence level: E
 
</ref><br>The scapholunate interosseous ligament(SLIL) is the link between carpal scaphoid and lunate bone. It ensures stability of the scapholunate joint and helps keep the entire wrist stabilized.  
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== Technique<br>  ==
 
Video in which the test is preformed : http://www.youtube.com/watch?v=DGH-pHmeLnQ <br>To preform the scaphoid shift test the patient should rest his arm with his elbow on the table and his forearm lifted. The examiner sits across the table and places his arm next to the patient's arm (like in an arm wrestling position right to right or left to left). The patient's hand is slightly pronated and the examiner places his thumb on the palmar side of the scaphoid (on the scaphoid tubercule), his other fingers are wrapped around the back of the wrist at the distal part of the radius. This will allow the examiner to put pressure on the scaphoid with his thumb. With his other hand the examiner holds the patient's hand at the metacarpal level. (1,2)
 
The hand is put into ulnar deviation and in slight dorsal flexion; in this position the scaphoid lies almost 'in line' with the ulna (fig2). From this position the hand is moved passively by the examiner into radial deviation and slight palmar flexion. Meanwhile a constant pressure is given by the thumb on the scaphoid tubercule. <br>During the radial deviation and slight palmar flexion, the distal part of the scaphoid tilts forward (fig 3) and thereby pushes against the examiner's thumb (which is pushing in the opposite direction) causing stress on the joints. (1,2,5)<br>This stress is overcome in a normal wrist (minimal movement can be tolerated), but results in a dorsal displacement ('shift') of the scaphoid in relation to the other carpal bones in the wrist of a patient with ligamentous laxity (fig 3). When the thumb force is then abruptly taken away the shift will be reduced and the scaphoid will fall back in its normal position, this may result in a painful 'thunk'. (1,2,5)<br>It is important to preform this technique on both wrists and compare them.<br>
 
== Differential Diagnosis  ==
 
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<br>
 
== Diagnostic Procedures  ==
 
1. MEDICAL DIAGNOSIS<br>A plain radiography or MRI is necessary to confirm the diagnose of a coccyx fracture. (level of evidence D)
 
<br>2. CLINICAL DIAGNOSIS<br>The diagnose is made after rectal examination. (level of evidence D)iv By passing the finger up the rectum and then pressing the bone backwards and forward, the unnatural degree of motion will then be felt. Related to the age and sex of the patient must be remembered that in the female this bone naturally possesses more motion than in the male, and that in youth a degree of motion, that does not exist at a later period of life, is present, allowing the ossification being less complete. However the free motion of the bone is taken as a symptom. (level of evidence D)
 
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== Outcome Measures ==
 
add links to outcome measures here (also see [[Outcome Measures|Outcome Measures Database]]) 
 
== Examination  ==
 
add text here related to physical examination and assessment<br>
 
== Medical Management <br>  ==
 
1. COCCYGEOPLASTY<br>By applying the novel techniques that are used in vertebroplasty and sacroplasty, coccygeoplasty is introduced as a new percutaneous treatment modality for fractures of the coccyx. This procedure can be helpful for patients with refractory pain resulting from a fracture of the coccyx and can be performed quickly and safely with high-resolution c-arm fluoroscopy. The coccygeal fracture treated with an injection of polymethylmethacrylate cement can provide early symptom relief. Although the promising results, an experience with a larger patient population is warranted. ( level of evidence C)
 
<br>2. COCCYGECTOMY<br>Literature reports suggest that coccygectomy, partial or total removal of the coccyx, has been beneficial with success rates as high as 60-91%. However, coccygectomy is a more invasive procedure, with a common complication rate as high as 22%, and is usually associated with perineal contamination of the wound. Other complications could include persistent bleeding from the hemorrhoidal venous complex of the rectum. (level of evidence C)ix
 
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== Physical Therapy Management <br>  ==
 
add text here <br>


== Key Research  ==
The scapholunate interosseous ligament is an intra-articular structure (ie, synovial) composed of three regions:<ref name=":6" /><ref>Pappou IP, Basel J, Deal DN. Scapholunate ligament injuries: a review of current concepts. ''Hand (N Y)'' 2013;8(2):146-56. PMID: 24426911 </ref>
* Dorsal ligament: transversely oriented collagen fibers providing primary restraint for distraction and torsional/translational movements
* Palmar ligament: provides rotational stability
* Proximal fibrocartilage: negligible contribution to restraint of abnormal motion


add links and reviews of high quality evidence here (case studies should be added on new pages using the [[Template:Case Study|case study template]])<br>  
== Technique  ==
{{#ev:youtube|DGH-pHmeLnQ }} <br>
To perform the scaphoid shift test, the patient should rest his arm with his elbow on the table and his forearm lifted. The examiner sits across the table and places his arm next to the patient's arm (like in an arm wrestling position right to right or left to left). The patient's hand is slightly pronated and the examiner places his thumb on the palmar side of the scaphoid (on the scaphoid tubercule), his other fingers are wrapped around the back of the wrist at the distal part of the radius. This will allow the examiner to put pressure on the scaphoid with his thumb. With his other hand the examiner holds the patient's hand at the metacarpal level. <ref name=":0" /><ref name=":3">A.P. Gleeson, et al.; 1996; Scapholunate instability - a spectrum of pathology;J. Accid Emerg Med 13:216-219 evidence level: F
</ref>The hand is put into ulnar deviation and in slight dorsal flexion; in this position the scaphoid lies almost 'in line' with the ulna. From this position the hand is moved passively by the examiner into radial deviation and slight palmar flexion. Meanwhile a constant pressure is given by the thumb on the scaphoid tubercule. During the radial deviation and slight palmar flexion, the distal part of the scaphoid tilts forward and thereby pushes against the examiner's thumb (which is pushing in the opposite direction) causing stress on the joints. <ref name=":0" /><ref name=":1" /><ref name=":4">S. W. Wolfe, et al.; 1994; Mechanical evaluation of the scaphoid shift test; Journal of Hand Surgery, volume 19A: 762-768 evidence level: C
</ref>This stress is overcome in a normal wrist (minimal movement can be tolerated), but results in a dorsal displacement ('shift') of the scaphoid in relation to the other carpal bones in the wrist of a patient with ligamentous laxity. When the thumb force is then abruptly taken away the shift will be reduced and the scaphoid will fall back in its normal position, this may result in a painful 'thunk'.<ref name=":0" /> <ref name=":3" /><ref name=":4" /> It is important to perform this technique on both wrists and compare them.<br>  


== Resources <br>  ==
== Interpretation  ==


add appropriate resources here <br>  
'''Positive test:'''  A palpable and/or audible reduction of the subluxed scaphoid<ref name=":6" /><ref name=":0" /> and elicitation of symptomatic pain, usually on the dorsal side.<ref name=":0" />  


== Clinical Bottom Line  ==
'''Negative test''': Scaphoid moves normally, pushing back on the examiner's thumb with ulnar deviation of the wrist, and there is no symptomatic pain.


add text here <br>  
Though Watson HK. has described this test more as a provocative then a test with a positive and negative result. An experienced examiner should be able to conclude a variety of findings from this test, the mobility itself should not directly be considered pathological because it may be caused by hypermobility syndrome. Though unilateral hyper mobility is rather suspicious. Pain similar to the patients symptoms during a dorsal shift indicates a symptomatic subluxation of the scaphoid, pain which is less localised combined with normal or limited movement may point in the direction of periscaphoid arthritis or scapho-Iunate advanced collapse pattern. A gritty, clicking or smooth sensation gives you an idea about the state of the articular cartilage and bony form of the joint. <ref name=":0" /><ref name=":3" /> When there are doubts and to have clear results about the actual shift, a radioscopy and mostly a fluoroscopy are used to get clear images and information about the shift test.<ref name=":2" /><ref name=":7">Scott W. Wolfe, et al.; 1997; Kinematics of the scaphoid shift test; Journal of Hand Surgery, volume 22A: 801-806 evidence level: C
</ref><ref name=":5">Min Jong Park; 2002; Radiographic observation of the scaphoid shift test; Journal of Bone and Joint Surgery, volume 85-B: 358-62. evidence level: C</ref> <br>  


== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])  ==
== Reliability    ==


see tutorial on [[Adding PubMed Feed|Adding PubMed Feed]]
As mentioned earlier, the scaphoid shift test is more a provocative then a test and needs to be interpreted carefully. This is also the conclusion made by most trials about the scaphoid shift test, several trials have shown us that around 32-36% of the uninjured population have a painless positive scaphoid shift test (only mechanical parameters where measured to determine whether the test is positive or negative during the trial); note that a high correlation between asymptomatic subluxable scaphoid and generalised ligamentous laxity has been noticed.<ref name=":2" /><ref name=":7" /> In the test, an examiner with great experience has been able to predict the presence of absence of the scaphoid shift with an accuracy of 82 and 88% respectively.<ref name=":4" /> A study has shown that the pain associated with the subluxation is significant (p&lt;0,05) to diagnose pathological dynamic scaphoid instability.<ref name=":5" />This confirms that the scaphoid shift test should be interpreted with great care, that the patients history, pain and feel of the movement are of more importance then the actual shift and therefore experience of the examiner is of great importance to evaluate the results.
<div class="researchbox">
<rss>Feed goes here!!|charset=UTF-8|short|max=10</rss>  
</div>  
== References  ==


see [[Adding References|adding references tutorial]].
== Related research  ==


<references />  
#&nbsp;J. J. Hwang, C. A. Goldfarb, et al.; 1999;The effect of dorsal carpal ganglion excision on the scaphoid shift test, Journal of Hand Surgery British and European Volume 24B: 1:106-108
#&nbsp;Ian Galley, MBchB, Gregory I. Bain, MBBS, James M. McLean, MBBS; 2007; Influence of Lunate Type on Scaphoid Kinematics;Journal of Hand Surgery 32A: 842–847
#Frederick W. Werner, et al.; 2005; Severity of Scapholunate Instability Is Related to Joint Anatomy and Congruency; Journal of Hand Surgery Volume 32, Issue 1, Pages 55-60 <br>


[[Category:Vrije_Universiteit_Brussel_Project|Template:VUB]]
== References  ==
<references />


MOORE K.L., DALLEY A.F., AGUR A.M.R., Clinically oriented anatomy: chapter 3: Pelvis and perineum, Wolters Kluwer health, sixth edition, 2010, pag. 451-452, level of evidence D<br> YU-TSAI T., LI-WEN T., CHENG-HSIU L., SHIH-WEI C., The influence of human coccyx in body weight shifting, medicine and science in sport and exercise, 2011, Volume 43, Number 5, pag. 494-496, level of evidence B<br> MOORE K.L., DALLEY A.F., AGUR A.M.R., Clinically oriented anatomy: chapter 3: Pelvis and perineum, Wolters Kluwer health, sixth edition, 2010, pag. 332, level of evidence D<br> HAARMAN H.J.Th.M., Klinische traumatologie, Elsevier gezondheidszorg, 2006, pag. 117, level of evidence D<br> MOORE K.L., DALLEY A.F., AGUR A.M.R., Clinically oriented anatomy: chapter 3: Pelvis and perineum, Wolters Kluwer health, sixth edition, 2010, pag. 461, level of evidence D<br> TEKIN L. et al., Coccyx fracture in patients with spinal cord injury, European journal of physical and rehabilitation medicine, March 2010, Volume 46, Number 1, pag. 43-46, level of evidence C<br> RAISSAKI M.T.,Fracture dislocation of the sacro-coccygeal joint: MRI evaluation, Pediatric radiology, March 1999, pag. 642-643, level of evidence D<br> LONSDALE E.F., A practical treatise on fractures, Walton and Mitchell printers, 1838, pag. 269-270, level of evidence D<br> MIYAMOTO K. et al., Exposure to pulsed low intensity ultrasound stimulates extracellular matrix metabolism of bovine intervertebral dosc cells cultured in alginate beads, Spine, November 2005, level of evidence B<br> EBNEZAR J., Essentials of orthopaedics for physiotherapist, Jaypee, 2003, pag. 174, level of evidence D<br> DEAN L.M. et al., Coccygeoplasty : treatment for fractures of the coccyx, J. Vasc. Interv. Radiol, 2006, pag. 909-912, level of evidence C<br> COOPER G., HERRERA J.E., Manual of musculoskeletal medicine, Wolters kluwer, Lippincott Williams &amp; Wilkins, 2008, pag. 144, level of evidence D&nbsp;
[[Category:Wrist]]
[[Category:Special_Tests]]
[[Category:Primary Contact]]
[[Category:Sports Medicine]]
[[Category:Athlete Assessment]]
[[Category:Assessment]]
[[Category:Wrist - Assessment and Examination]]
[[Category:Wrist - Special Tests]]

Latest revision as of 18:55, 7 August 2023

Original Editors- Rik Van der Hoeven Top Contributors - Rik Van der Hoeven, Simisola Ajeyalemi, Laurien Henau, Kim Jackson, Admin, George Prudden, Claire Knott, Wanda van Niekerk and Matt Huey -Rik Van der Hoeven

Purpose[edit | edit source]

The scaphoid shift test is a provocative maneuver used to examine the dynamic stability of the scaphoid and reproduce a patient's symptoms. It is used to diagnose scapholunate interosseous ligament instability (SLIL).[1] Watson first described the test to the American Research in General Orthopedics conference in New Orleans in March 1978. The test is found helpful during the examination of the wrist and more specifically the scaphoid. Beside the stability, the examiner will also be able to reflect the quality of the adjoining articular surfaces.[2][3]

Clinically Relevant Anatomy[edit | edit source]

The ligaments that are thought to provide the principle support to the scaphoid are the radioscaphocapitate ligament, the scaphoid-trapezoid-trapezium ligament and the scapholunate interosseous ligament. [4]
The scapholunate interosseous ligament(SLIL) is the link between carpal scaphoid and lunate bone. It ensures stability of the scapholunate joint and helps keep the entire wrist stabilized.

The scapholunate interosseous ligament is an intra-articular structure (ie, synovial) composed of three regions:[1][5]

  • Dorsal ligament: transversely oriented collagen fibers providing primary restraint for distraction and torsional/translational movements
  • Palmar ligament: provides rotational stability
  • Proximal fibrocartilage: negligible contribution to restraint of abnormal motion

Technique[edit | edit source]


To perform the scaphoid shift test, the patient should rest his arm with his elbow on the table and his forearm lifted. The examiner sits across the table and places his arm next to the patient's arm (like in an arm wrestling position right to right or left to left). The patient's hand is slightly pronated and the examiner places his thumb on the palmar side of the scaphoid (on the scaphoid tubercule), his other fingers are wrapped around the back of the wrist at the distal part of the radius. This will allow the examiner to put pressure on the scaphoid with his thumb. With his other hand the examiner holds the patient's hand at the metacarpal level. [2][6]The hand is put into ulnar deviation and in slight dorsal flexion; in this position the scaphoid lies almost 'in line' with the ulna. From this position the hand is moved passively by the examiner into radial deviation and slight palmar flexion. Meanwhile a constant pressure is given by the thumb on the scaphoid tubercule. During the radial deviation and slight palmar flexion, the distal part of the scaphoid tilts forward and thereby pushes against the examiner's thumb (which is pushing in the opposite direction) causing stress on the joints. [2][4][7]This stress is overcome in a normal wrist (minimal movement can be tolerated), but results in a dorsal displacement ('shift') of the scaphoid in relation to the other carpal bones in the wrist of a patient with ligamentous laxity. When the thumb force is then abruptly taken away the shift will be reduced and the scaphoid will fall back in its normal position, this may result in a painful 'thunk'.[2] [6][7] It is important to perform this technique on both wrists and compare them.

Interpretation[edit | edit source]

Positive test: A palpable and/or audible reduction of the subluxed scaphoid[1][2] and elicitation of symptomatic pain, usually on the dorsal side.[2]

Negative test: Scaphoid moves normally, pushing back on the examiner's thumb with ulnar deviation of the wrist, and there is no symptomatic pain.

Though Watson HK. has described this test more as a provocative then a test with a positive and negative result. An experienced examiner should be able to conclude a variety of findings from this test, the mobility itself should not directly be considered pathological because it may be caused by hypermobility syndrome. Though unilateral hyper mobility is rather suspicious. Pain similar to the patients symptoms during a dorsal shift indicates a symptomatic subluxation of the scaphoid, pain which is less localised combined with normal or limited movement may point in the direction of periscaphoid arthritis or scapho-Iunate advanced collapse pattern. A gritty, clicking or smooth sensation gives you an idea about the state of the articular cartilage and bony form of the joint. [2][6] When there are doubts and to have clear results about the actual shift, a radioscopy and mostly a fluoroscopy are used to get clear images and information about the shift test.[3][8][9]

Reliability[edit | edit source]

As mentioned earlier, the scaphoid shift test is more a provocative then a test and needs to be interpreted carefully. This is also the conclusion made by most trials about the scaphoid shift test, several trials have shown us that around 32-36% of the uninjured population have a painless positive scaphoid shift test (only mechanical parameters where measured to determine whether the test is positive or negative during the trial); note that a high correlation between asymptomatic subluxable scaphoid and generalised ligamentous laxity has been noticed.[3][8] In the test, an examiner with great experience has been able to predict the presence of absence of the scaphoid shift with an accuracy of 82 and 88% respectively.[7] A study has shown that the pain associated with the subluxation is significant (p<0,05) to diagnose pathological dynamic scaphoid instability.[9]This confirms that the scaphoid shift test should be interpreted with great care, that the patients history, pain and feel of the movement are of more importance then the actual shift and therefore experience of the examiner is of great importance to evaluate the results.

Related research[edit | edit source]

  1.  J. J. Hwang, C. A. Goldfarb, et al.; 1999;The effect of dorsal carpal ganglion excision on the scaphoid shift test, Journal of Hand Surgery British and European Volume 24B: 1:106-108
  2.  Ian Galley, MBchB, Gregory I. Bain, MBBS, James M. McLean, MBBS; 2007; Influence of Lunate Type on Scaphoid Kinematics;Journal of Hand Surgery 32A: 842–847
  3. Frederick W. Werner, et al.; 2005; Severity of Scapholunate Instability Is Related to Joint Anatomy and Congruency; Journal of Hand Surgery Volume 32, Issue 1, Pages 55-60

References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 Kitay A, Wolfe SW. Scapholunate instability: current concepts in diagnosis and management. J Hand Surg Am 2012;37(10):2175-96.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 H. Kirk Watson, et al.; 1988; Examination of the scaphoid; Journal of Hand Surgery, volume: 13A, 657-60. evidence level: F
  3. ↑ 3.0 3.1 3.2 Kenneth J. Easterling, et al.; 1994; Scaphoid Shift in the Uninjured Wrist; Journal of Hand Surgery, volume: 19A, 604-606 evidence level: C
  4. ↑ 4.0 4.1 Wozasek GE, Laske H; 1991; The ligaments of the scaphoid bone; Handchir Mikrochir Plast Chir. Volume 23(1):18-22 evidence level: E
  5. ↑ Pappou IP, Basel J, Deal DN. Scapholunate ligament injuries: a review of current concepts. Hand (N Y) 2013;8(2):146-56. PMID: 24426911 
  6. ↑ 6.0 6.1 6.2 A.P. Gleeson, et al.; 1996; Scapholunate instability - a spectrum of pathology;J. Accid Emerg Med 13:216-219 evidence level: F
  7. ↑ 7.0 7.1 7.2 S. W. Wolfe, et al.; 1994; Mechanical evaluation of the scaphoid shift test; Journal of Hand Surgery, volume 19A: 762-768 evidence level: C
  8. ↑ 8.0 8.1 Scott W. Wolfe, et al.; 1997; Kinematics of the scaphoid shift test; Journal of Hand Surgery, volume 22A: 801-806 evidence level: C
  9. ↑ 9.0 9.1 Min Jong Park; 2002; Radiographic observation of the scaphoid shift test; Journal of Bone and Joint Surgery, volume 85-B: 358-62. evidence level: C
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