Adduction Test | Carpometacarpal 1 Osteoarthritis | Thumb OA

Thumb osteoarthritis (OA) is a painful and debilitating condition that affects a large proportion of the adult population, with radiographic prevalence reaching 90% in both men and women by the age of 80. This condition can cause pain at the base of the thumb, progressive loss of thumb motion, weakness, and decreased coordination, which worsens over time.

Qualitative assessment of the history, physical examination, and radiographs are used to diagnose and treat thumb CMC arthritis. The location, duration, onset, frequency, intensity, and quality of the pain are all under consideration.

Gelberman et al. (2015) evaluated this test and found a sensitivity of 94% and specificity of 93% and inter-rater reliability Kappa coefficient of 0.79. Despite these excellent values the study represents several limitations for this novel assessment test and until further validation of this test in different settings has taken place, we give it a moderate clinical value.

Despite these excellent values the study represents several limitations for this novel assessment test and until further validation of this test in different settings has taken place, we give it a moderate clinical value.

To conduct the test, the patient is in sitting position across from the examiner. The patient’s hand is placed on the examination table with the elbow flexed to 90 degrees and the forearm in neutral rotation. While the examiner supports the patient’s ulnar side of the hand to maintain the wrist in neutral position and to prevent ulnar deviation, the other hand is placed such that the examiner’s thumb rests dorsally over the head of the thumb metacarpal.

Then the examiner firmly directs an adduction force downward onto the patient’s metacarpal head until the patient’s thumb metacarpal lies parallel to the mid axis of the index metacarpal or until a firm end-feel is reached.

The test is considered positive if the patient’s pain at the TMC joint is reproduced.

21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE

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Other orthopedic tests to assess CMC1 osteoarthritis are:

• Grind Test
• Pressure Shear Test
• MC Extension Test
• MC Flexion Test
• Traction-Shift/Subluxation Relocation Test
• Extension Stress Test

References

Gelberman, R. H., Boone, S., Osei, D. A., Cherney, S., & Calfee, R. P. (2015). Trapeziometacarpal arthritis: a prospective clinical evaluation of the thumb adduction and extension provocative tests. The Journal of hand surgery, 40(7), 1285-1291.