Scaphoid shift test

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Original Editors- Rik Van der Hoeven

Lead Editors -Rik Van der HoevenEditors

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search engines: PubMed, Science Direct, Web of Knowledge and Google

keywords: scaphoid shift test, wrist pain, os scaphoid and wrist.

Purpose

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)

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)

Technique

Video in which the test is preformed : http://www.youtube.com/watch?v=DGH-pHmeLnQ
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.
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)
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)
It is important to preform this technique on both wrists and compare them.

Interpretation

The scaphoid shift test may be considered negative if the examiner can feel the scaphoid rotating and pushing his thumb away during radial deviation. The test may be considered positive when the pressure of the thumb prevented the scaphoid from tilting forward and results in a dorsal movement of the scaphoid out of the elliptic fossa of the radius. (1,8)
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. (1,2)
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. (3,4,6)

Reliability

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 has 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.(3,4) In a 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.(5) A study has shown that the pain associated with the subluxation is significant (p<0,05) to diagnose pathological dynamic scaphoid instability.(6)
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

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
   

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