Lunotriquetral shear test

Lunotriquetral Shear Test is a clinical physical examination maneuver used to assess the integrity of the lunotriquetral ligament in the wrist. This test is particularly useful in diagnosing lunotriquetral instability, a condition that can result from injury or degeneration of the ligament. The lunotriquetral ligament is a key stabilizer of the proximal carpal row, specifically between the lunate and triquetrum bones of the wrist.

Procedure

The Lunotriquetral Shear Test is performed with the patient seated or standing. The examiner stabilizes the patient's forearm with one hand, while the other hand grasps the patient's hand. The examiner then applies a dorsally directed force to the lunate with the thumb and a volarly directed force to the triquetrum with the fingers. This maneuver creates a shearing force across the lunotriquetral joint. The test is considered positive if it elicits pain or a "click" in the lunotriquetral joint, which may indicate lunotriquetral ligament tear or instability.

Indications

The Lunotriquetral Shear Test is indicated in patients presenting with ulnar-sided wrist pain, especially if the pain is exacerbated by activities that involve wrist rotation or gripping. It is also useful in the evaluation of patients with a history of trauma to the wrist, such as a fall on an outstretched hand, which could lead to ligamentous injury.

Limitations

While the Lunotriquetral Shear Test can be a valuable tool in the diagnosis of lunotriquetral instability, it is not definitive. A positive test should prompt further investigation, such as advanced imaging studies like MRI or arthroscopy, to confirm the diagnosis. Additionally, the test's sensitivity and specificity can vary, and it may not be positive in all cases of lunotriquetral ligament injury.

Related Conditions

• Kienbock's Disease
• TFCC Tear (Triangular Fibrocartilage Complex Tear)
• Carpal Instability
• Wrist Sprain

See Also

• Watson's Test
• Finkelstein's Test
• Phalen's Maneuver
• Allen's Test