Hand/Wrist Assessment

Traction-Shift Test / Subluxation Relocation Test | Thumb CMC1 OA

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Traction shift test

Traction-Shift Test / Subluxation Relocation Test | Thumb CMC1 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.

Choa et al. (2014) evaluated this test and found a sensitivity of 66.7% and a specificity of 100%. The traction-shift test both confirms the diagnosis of CMC osteoarthritis and may distinguish those who do not have it. A negative test, however, does not always imply negative radiographic evidence of thumb CMC osteoarthritis. With OA it has to be added that it remains a clinical diagnosis and changes seen on radiographic imaging don’t necessarily need to cause any disability or pain, which is why we give this test a moderate clinical value

>The test is done using a single-handed technique. The examiner applies longitudinal traction to the thumb and then alternates dorsal and palmar pressure over the base of the metacarpal to provoke subluxation and then relocation of the joint.

The test is positive if it elicits pain within the joint.

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Other orthopedic tests to assess CMC1 osteoarthritis are:

 

References

Choa, R. M., Parvizi, N., & Giele, H. P. (2014). A prospective case-control study to compare the sensitivity and specificity of the grind and traction-shift (subluxation-relocation) clinical tests in osteoarthritis of the thumb carpometacarpal joint. Journal of Hand Surgery (European Volume), 39(3), 282-285.

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