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Thumb (Grind) Compression Test

Exams and Signs

Historical Overview

  • The grind test is commonly used to test for osteoarthritis carpometacarpal (CMC) of the thumb, but its origin is not certain.

Description

  • A positive test evokes pain (tenderness) and gives the sensation of joint surfaces roughly grinding against each other.1

Pathophysiology

  • A positive test suggests the presence of osteoarthritis at the CMC joint (also known as the trapeziometacarpal joint).1

Instructions2

  1. Grasp the thumb metacarpal shaft
  2. Move the thumb in a circular motion
  3. Apply axial compression
  4. Alternative thumb subluxation of the arthritic CMC joint is firmly reduced to reproduce the patient symptoms.

Variations

  • Variations have not been systemically catalogued, but they are known to affect its diagnostic performance.3

Related Signs and Tests

  • “Distraction” or “torque” test4
  • Palpation of the CMC joint1
  • Traction-Shift test5

Diagnostic Performance Characteristics

Citation

Sensitivity*

Specificity†

PPV‡

NPV§

Merritt et al. (2010)3

42%, 53%

80%, 93%

91%, 96%

68%, 70%

*Sensitivity: true positive rate; proportion of actual positives that are correctly identified as such. The two values shown for the Merritt et al. study are values for two examiners.
†Specificity: true negative rate; proportion of actual negatives that are correctly identified as such. The two values shown for the Merritt et al. study are values for two examiners.
‡Positive predictive value (PPV): measure of precision; true positives / total number of positives (depends on prevalence). The two values shown for the Merritt et al. study are values for two examiners.

§Negative predictive value (NPV): true negatives / total number of negatives (depends on prevalence).

Note: the 2 values shown for each parameter are values for 2 examiners.

Presentation Photos and Related Diagrams
  • Thumb CMC Grind (Compression) Test.
    Thumb CMC Grind (Compression) Test.
Definition of Positive Result
  • A positive result occurs when the patient feels pain and the maneuver reproduces their symptoms. The examiner should feel crepitance at the thumb CMC joint as the joint is manipulated and partial reduced2
Definition of Negative Result
  • A negative result occurs when the patient does not feel pain and crepitance at the thumb CMC joint when the test is administered.
Comments and Pearls
  • A negative grind test does not necessarily reflect negative radiographic evidence of thumb CMC osteoarthritis.3
  • A positive grind test does not necessarily reflect positive radiographic evidence of thumb CMC osteoarthritis.3   Chondromalacia with or without significant joint laxity can also cause a positive grind test.
  • Carpal tunnel syndrome, scaphotrapezial  arthrosis, trigger digits, MCP hyperextension and tenosynovitis of the wrist may be associated with basal thumb osteoarthritis
Diagnoses Associated with Exams and Signs
Videos
Thumb CMC Compression Test (Grind Test)
YouTube Videos
Thumb CMC Osteoarthritis
References
  1. Rayan G and Akelman E. The Hand: Anatomy, Examination, and Diagnosis. Philadelphia: Lippincott Williams & Wilkins, 2012.
  2. Culp R and Jacoby S. Musculoskeletal Examination of the Elbow, Wrist, and Hand: Making the Complex Simple. Thorofare: Slack Inc., 2012.
  3. Merritt M et al Diagnostic value of clinical grind test for carpometacarpal osteoarthritis of the thumb. J Hand Ther 2010; 23(3): 261-7. PMID: 20452743
  4. Dias R, et al. Basal thumb arthritis. Postgrad Med 2007; 83(975): 40–43. PMID: 17267677
  5. Choa R Parvizi N, Giele H. 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. J Hand Surg Eur 2014;39(3):282-5. PMID: 24127463
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