The diagnostic clinical value of thumb metacarpal grind, pressure-shear, flexion, and extension tests for carpometacarpal osteoarthritis

J Hand Ther. 2019 Jan-Mar;32(1):35-40. doi: 10.1016/j.jht.2017.09.005. Epub 2017 Nov 14.


Study design: Clinical measurement.

Introduction: Common provocative maneuvers to differentiate thumb carpometacarpal (CMC) osteoarthritis from other sources of pain are the grind, metacarpal (MC) flexion, and MC extension tests. A maneuver known as the pressure-shear test is described here.

Purpose of the study: To compare the diagnostic value of the grind, metacarpal flexion, metacarpal extension, and pressure-shear tests for CMC osteoarthritis of the thumb.

Methods: The diagnostic accuracy of each test was compared in 127 thumbs from 104 patients. Sensitivity, specificity, and predictive values of each test were calculated. In a secondary analysis, polychoric correlation coefficients were used to assess the correlation of each test with severity defined by Eaton-Littler stage.

Results: The overall diagnostic accuracy of the thumb MC grind, pressure-shear, flexion, and extension tests were 70%, 98%, 47%, and 55%, respectively. The sensitivities were 64%, 99%, 36%, and 46%, respectively, and specificities were 100%, 95%, 100%, and 100%, respectively. For the diagnosis of Thumb CMC arthritis, the MC pressure-shear test was superior overall in terms of overall diagnostic accuracy and sensitivity, while having comparable specificity to the other maneuvers.

Conclusion: The pressure-shear test was found to be superior to the commonly used grind maneuver and the provocative maneuvers of MC flexion and extension tests to confirm diagnosis of CMC osteoarthritis.

Keywords: Grind test; Metacarpal extension test; Metacarpal flexion test; Pressure-shear test; Thumb carpometacarpal arthritis.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Carpometacarpal Joints / physiopathology*
  • Female
  • Humans
  • Male
  • Metacarpal Bones / physiopathology*
  • Middle Aged
  • Osteoarthritis / classification
  • Osteoarthritis / diagnosis*
  • Osteoarthritis / physiopathology
  • Physical Examination / methods*
  • Predictive Value of Tests
  • Sensitivity and Specificity
  • Thumb / physiopathology*
  • Young Adult