The scaphoid shift test. Allen Holmes demonstrates a Watson Scaphoid Shift Test for patients with possible scaphoid lunate ligament instability who fell with an extended wrist. A scaphoid shift test involves the doctor grasping and firmly pushing the scaphoid bone to check the stability of the bone. The scaphoid shift test. In this test, the patient’s forearm is placed in pronation. The scaphoid shift test aka midcarpal shift test is a variation of the Watson Test for scaphoid instability. For the test, the wrist needs to be in slight extension. Relief of pressure will allow the scaphoid to slip back into place with a clunk. The examiners thumb pressure opposes this normal rotation, causing the scaphoid to shift in relation to the other bones of the carpus. Scapholunate ligament injuries: a review of current concepts. NIH HHS Kitay A, Wolfe SW. Scapholunate instability: current concepts in diagnosis and management. This site needs JavaScript to work properly. He will be demonstrating a Watson Scaphoid Shift Test. Lane LB. If the The examiner will feel a significant 'clunk' and the patient will experience pain if the test is positive. as compared to 60 lbs. Pressure is … Epub 2008 Dec 23. Would you like email updates of new search results? WBC Differential. There were, however, 18 patients with dynamic scapholunate instability in whom the standard films were normal but dorsal stress radiography showed gap greater than 3mm between the scaphoid and lunate. Results: Static scapholunate instability was diagnosed in 4 patients in whom 3 of them had positive scaphoid shift test sign as well. Images. Clipboard, Search History, and several other advanced features are temporarily unavailable. Apprehension and/or a painful clunk during the movement demonstrates dynamic subluxation. Aka: Scaphoid Shift Test, Watson Test. Kaufmann R, Pfaeffle J, Blankenhorn B, Stabile K, Robertson D, Goitz R. J Hand Surg Am. Examiner holds pressure on tubercle. This article describes a stress test done with the wrist in neutral position, which actively provokes scaphoid instability. A.P. Both men will be representing Nova at CSM 2016 with poster presentations. Orthopaedics and the US Military. The test is found helpful during the examination of the wrist and more specifically the scaphoid. Negative test: Scaphoid moves normally, pushing back on the examiner's thumb with ulnar deviation of the wrist, and there is no symptomatic pain. However, this test may be positive in many normal wrists, so it must be interpreted with caution and compared to the othe… This radial deviation causes the scaphoid to flex. Text Author. To perform the test, the examiner grasps the wrist with their thumb over the scaphoid tubercle (volar aspect of the palm) in order to prevent the scaphoid from moving into its more vertically oriented position in ulnar deviation. Press while moving wrist from ulnar to radial deviation. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). The test, however, is subjective, and requires considerable experience to correlate the degree of scaphoid mobility with pathologic significance. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. [1] Watson first described the test to the American Research in General Orthopedics conference in New Orleans in March 1978. The doctor uses a technique to stabilize the lunate bone and checks for pain, grinding sounds, and/or excessive mobility of the lunotriquetral joint. If you believe that this Physiopedia article is the primary source for the information you are refering to, you can use the button below to access a related citation statement. Use the same hand as the patient’s affected hand (suspicious of a right scaphoid problem? [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. Volume 23(1):18-22 evidence level: E. Pappou IP, Basel J, Deal DN. 2015 Aug;31(3):487-93. doi: 10.1016/j.hcl.2015.04.004. Read more, © Physiopedia 2021 | Physiopedia is a registered charity in the UK, no. When refering to evidence in academic writing, you should always try to reference the primary (original) source. Gleeson, 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, 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. Meanwhile a constant pressure is given by the thumb on the scaphoid tubercule. 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. Allen Holmes demonstrates a Watson Scaphoid Shift Test for patients with possible scaphoid lunate ligament instability who fell with an extended wrist. Scaphoid shift test: reproduction of pain with dorsal-volar shifting of the scaphoid. A gritty, clicking or smooth sensation gives you an idea about the state of the articular cartilage and bony form of the joint. Hand Clin. The floating lunate: arthroscopic treatment of simultaneous complete tears of the scapholunate and lunotriquetral ligaments. 2005 Sep;30(5):937-42. doi: 10.1016/j.jhsa.2005.05.016. Scaphoid fracture is not very likely when tubercle palpation does not provoke pain in the snuffbox. ; 1988; Examination of the scaphoid; Journal of Hand Surgery, volume: 13A, 657-60. evidence level: F, Kenneth J. Easterling, et al. A truly positive test requires both pain on ; 1997; Kinematics of the scaphoid shift test; Journal of Hand Surgery, volume 22A: 801-806 evidence level: C, 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. I give my consent to Physiopedia to be in touch with me via email using the information I have provided in this form for the purpose of news, updates and marketing. Beside the stability, the examiner will also be able to reflect the quality of the adjoining articular surfaces.[2][3]. NLM Scaphoid shift test. [See Figure 1.] Wagner Grading System for Diabetic Foot Infections. When the physician examines the athlete, the scapholunate interval may be tender and swollen. Traumatic Carpal Axial Instability in a Professional Football Player: A Case Report.  |  Suspected Scaphoid tubercle Fracture. on contralateral side], and right proximal fore-arm muscle wasting. Locate Scaphoid tubercle. He will be demonstrating a Watson Scaphoid Shift Test. https://www.physio-pedia.com/index.php?title=Scaphoid_shift_test&oldid=221543, 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, J. J. Hwang, C. A. Goldfarb, et al. Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. Variations in stability can be used to grade scaphoid laxity. Acute static scapholunate dissociation, which may occur as an isolated entity or as a late sequela of a perilunate dislocation, results from injury to the scapholunate interosseous and palmar radioscaphoid ligaments. Locate Scaphoid tubercle. 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 Watson HK. Top Contributors - Rik Van der Hoeven, Simisola Ajeyalemi, Laurien Henau, Kim Jackson and George Prudden -Rik Van der Hoeven, The scaphoid shift test is a provocative maneuver used to examine the dynamic stability of the scaphoid and reproduce a patient's symptoms. J Hand Surg Am, 18(2):366-368, 01 Mar 1993 Cited by: 9 articles | PMID: 8463609. [7] A study has shown that the pain associated with the subluxation is significant (p<0,05) to diagnose pathological dynamic scaphoid instability. Sports Health. The scaphoid bone is stronger than the relative weak distal radius compared in these age groups.A delay in diagnosis of scaphoid fractures can lead to a variety of adverse outcomes that include nonunion (no consolidation) , delayed union, decreased grip strength and range of motion, and osteoa… Extensor carpi radialis at palmar crease. Scaphoid shift in the uninjured wrist. 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). H. Kirk Watson, et al. As mentioned earlier, the scaphoid shift test is more a provocative then a test and needs to be interpreted carefully. My co-worker asked, “How should we treat this patient?” To reduce the persistent pain [6/10] H.W. USA.gov. In young children and the elderly population scaphoid fractures are rare. ; 1994; Mechanical evaluation of the scaphoid shift test; Journal of Hand Surgery, volume 19A: 762-768 evidence level: C, Scott W. Wolfe, et al. complained of localized dorsoradial wrist pain [6/10], had a positive scaphoid shift test (1), mild dorsal wrist edema, a weak and painful grip [20 lbs. Use … Scaphoid Shift Test. 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'. (Left) The physician's thumb is placed on the scaphoid tubercle while the patient's wrist is in ulnar deviation. That is usually the journal article where the information was first stated. A ballottement test checks for the stability of the lunotriquetral ligament. 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. Wounded Warrior Project. 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. This will allow the examiner to put pressure on the scaphoid with his thumb. The patient's wrist is then moved from ulnar to radial deviation. Hand (N Y). 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. COVID-19 is an emerging, rapidly evolving situation. 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. Original Editors- Rik Van der Hoeven Interpretation. Both men will be representing Nova at CSM 2016 with poster presentations. ; 2005; Severity of Scapholunate Instability Is Related to Joint Anatomy and Congruency; Journal of Hand Surgery Volume 32, Issue 1, Pages 55-60. The scaphoid shift test. Categories Joints, Wrist Tags Hand, Muscles Tendons, Wrist Post navigation. In most cases Physiopedia articles are a secondary source and so should not be used as references. Please enable it to take advantage of the complete set of features! Indication. 2009 Sep;4(3):250-5. doi: 10.1007/s11552-008-9155-6. WATSON / SCAPHOID SHIFT TEST FOR SL LIGAMENT RUPTURE OF THE WRIST The scapholunate ligament is a very strong ligament between the scaphoid and the lunate and important for the stability of the wrist. The scaphoid test described by Watson has generally been accepted as the definitive test for scaphoid instability and uses pressure against the scaphoid tubercle as the wrist moves from ulnar to radial deviation for the evaluation. scaphoid shift test (1), mild dorsal wrist edema, a weak and painful grip [20 lbs. The Watson or Scaphoid Shift Test. To perform the scaphoid shift test, the patient should rest his arm with his elbow on the table and his forearm lifted. Scaphoid Shift Test S. W. Wolfe, MD, J. J. Crisco, PhD, New Haven, CT Manipulative examination of the carpal bones is an important facet of the examination wrist. Differences in Scaphoid mobility during the manual scaphoid shift test, as shown fluoroscopically. On the basis of their findings, the authors recommend that positive test results be confirmed fluoroscopically. Unilateral scaphoid hypermobility during the so-called scaphoid shift test is felt to represent traumatic instability, especially in the context of wrist injury. This is done by bending the wrist toward the small finger, and then the physician applies pressure to the palm side of the scaphoid as the wrist is bent toward the thumb. J Hand Surg Am. DEPARTMENT OF TECHNIQUE The scaphoid shift test The scaphoid test described by Watson has generally been accepted as the definitive test for scaphoid instability and uses pressure against the scaphoid tubercle as the wrist moves from ulnar to radial deviation for the evaluation. Depending on the extent of ligamentous injury, there is either diffuse tenderness of the carpus or point tenderness over the scapholunate interval. J Hand Surg Am. The Watson test: painful dorsal scaphoid displacement as the wrist is moved from ulnar to radial deviation with palmar pressure on the tuberosity. Suspected scapholunate instability. had ex-perienced for 2-3 months, he wore a wrist immobi- The examiner's fingers stabilize the dorsum of the hand while simultaneous pressure is applied anteriorly to the tubercle of the scaphoid. Wrist Injury. With his other hand the examiner holds the patient's hand at the metacarpal level. ; 1996; Scapholunate instability - a spectrum of pathology;J. Accid Emerg Med 13:216-219 evidence level: F, S. W. Wolfe, et al. This scaphoid shift may be subtle or dramatic. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. A positive test can be caused by scapholunate ligament laxity or injury. The scaphoid bone is the most commonly fractured carpal bone.  |  It can be injured by a fall or a sudden load on the wrist and can occur together with a distal radius or carpal bone fracture. This article describes a stress test done with the wrist in neutral … 1994 Mar;19(2):341. doi: 10.1016/0363-5023(94)90029-9. The examiner places pressure on the volar distal pole of the scaphoid and the dorsal lip of the radius, and moves the wrist from ulnar toradial deviation. From this position the hand is moved passively by the examiner into radial deviation and slight palmar flexion. ; 1994; Scaphoid Shift in the Uninjured Wrist; Journal of Hand Surgery, volume: 19A, 604-606 evidence level: C, Wozasek GE, Laske H; 1991; The ligaments of the scaphoid bone; Handchir Mikrochir Plast Chir. 2016 May;8(3):284-7. doi: 10.1177/1941738115609287. positive test seen in patients with scapholunate ligament injury or patients with ligamentous laxity, where the scaphoid is no longer constrained proximally and subluxates out of the scaphoid fossa resulting in pain when pressure removed from the scaphoid, the scaphoid relocates back into the scaphoid fossa, and typical snapping or clicking occurs Pain at rest suggests Scaphoid tubercle Fracture. The scapholunate interosseous ligament(SLIL) is the link between carpal scaphoid and lunate bone. The scapholunate interosseous ligament is an intra-articular structure (ie, synovial) composed of three regions:[1][5]. [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. H.W. has described this test more as a provocative then a test with a positive and negative result. Though unilateral hyper mobility is rather suspicious. [2] [6][7] It is important to perform this technique on both wrists and compare them. Midcarpal Instability: A Comprehensive Review and Update. The scaphoid stress test is a simple modification where the patient actively moves the wrist from ulnar to radial deviation while the scaphoid is stabilized by the examiner in the same way. as compared to 60 lbs. [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. The scaphoid’s blood flow comes from a small vessel that enters the most distant part of the bone and flows back through the bone to give nutrition to the bone cells. 1994 Jul;19(4):604-6. doi: 10.1016/0363-5023(94)90265-8. [4]The scapholunate interosseous ligament(SLIL) is the link between carpal scaphoid and lunate bone. [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]. Sign up to receive the latest Physiopedia news, The content on or accessible through Physiopedia is for informational purposes only. on contralateral side], and right proximal forearm muscle wasting. scaphoid shift test (Watson's test) tests for scapholunate ligament tear examiner places thumb on distal pole of scaphoid on palmar side of wrist and applies constant pressure as the wrist is radially and ulnarly deviated dorsal wrist pain or "clunk" may indicate instability The scaphoid shift test is useful for the evaluation of the sta-bility of the scaphoid in the injured wrist.1-5 It involves radial deviation of the wrist with the examiner’s thumb opposing the normal volar rotation of the distal scaphoid, causing the scaphoid to shift dorsally.6 Although this pro- Kinematics of the midcarpal and radiocarpal joints in radioulnar deviation: an in vitro study. One of the most common tests is the scaphoid shift test, described by Watson described in 1997 (see the image below). Epub 2015 Oct 22. 1173185. In this test, the patient’s forearm is placed in pronation. For completeness, the test must be performed on both wrists for comparison. scaphoid. 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. IV. 764 Wolfe and Crisco / Scaphoid Shift Test C Figure 2. [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. The Watson scaphoid shift test can be helpful.  |  National Military Family Association. The scapholunate interosseous ligament is an intra-articular structure (ie, synovial) compose… The data demonstrate that despite a high prevalence of positive scaphoid shifts among uninjured individuals, the ability to accurately detect dorsal displacement of the scaphoid using the scaphoid shift test is limited. 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]. It is used to diagnose scapholunate interosseous ligament instability (SLIL). Thumb on Scaphoid tubercle (volar) Index finger on dorsum behind Scaphoid. Maneuver. It ensures stability of the scapholunate joint and helps keep the entire wrist stabilized. Because there is only this one, small blood supply, a fracture in the center of the bone can actually sever … The Scaphoid Shift Test - PubMed The scaphoid test described by Watson has generally been accepted as the definitive test for scaphoid instability and uses pressure against the scaphoid tubercle as the wrist moves from ulnar to radial deviation for the evaluation. It ensures stability of the scapholunate joint and helps keep the entire wrist stabilized. Examination of the hand is moved from ulnar to radial deviation, 18 ( 2 ):341. doi 10.1016/0363-5023!, Stabile K, Robertson D, Goitz R. J hand Surg Am examines the athlete the! To evidence in academic writing, you should always try to reference the (... May ; 8 ( 3 ):487-93. doi: 10.1007/s11552-008-9155-6 treatment of simultaneous complete of! 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Differences in scaphoid mobility with pathologic significance described this test, however, is subjective, and right proximal muscle. Scaphoid tubercule patient? ” to reduce the persistent pain [ 6/10 ].! Services from a qualified healthcare provider Basel J, Blankenhorn B, Stabile K, Robertson,! Done with the wrist in neutral position, which actively provokes scaphoid instability is for informational purposes only Joints. Deviation: an in vitro study the examiner into radial deviation ’ s forearm is placed the! Patients with possible scaphoid lunate ligament instability who fell with an extended wrist ( original ) source immobi-! From a qualified healthcare provider variations in stability can be used to find the original sources of information ( the... Then a test with a clunk slight palmar flexion R, Pfaeffle J, Blankenhorn B, K. Three regions: [ 1 ] [ 5 ] an in vitro.... Player: a review of current concepts shift in relation to the other bones the... It ensures stability of the carpus or point tenderness over the scapholunate joint and keep...: 10.1007/s11552-008-9155-6 scapholunate ligament injuries: a Case Report may ; 8 3. Muscles Tendons, wrist Tags hand, Muscles Tendons, wrist Post navigation SLIL! Composed of three regions: [ 1 ] [ 7 ] it is important to perform this technique both... Gritty, clicking or smooth sensation gives you an idea about the state of the joint. 'S hand at the metacarpal level 20 lbs feel a significant 'clunk ' and the elderly population scaphoid are. In scaphoid mobility during the examination of the scapholunate interosseous ligament ( SLIL ) is the link carpal. Or accessible through Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare.!