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Scaphoid Shift Test

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1. Scaphoid Shift Test

Scaphoid Shift Test Scaphoid Shift Test Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Scaphoid Shift Test Scaphoid Shift Test Aka (...) : Scaphoid Shift Test , Watson Test II. Indication Suspected tubercle Suspected scapholunate instability III. Maneuver Images Locate tubercle Extensor carpi radialis at palmar crease Examiner holds pressure on tubercle Thumb on tubercle (volar) Index finger on dorsum behind Press while moving wrist from ulnar to radial deviation IV. Interpretation Pain at rest suggests tubercle Pain or clunk suggests scapholunate instability V. References Images: Related links to external sites (from Bing) These images

2018 FP Notebook

2. Scaphoid Shift Test

Scaphoid Shift Test Scaphoid Shift Test Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Scaphoid Shift Test Scaphoid Shift Test Aka (...) : Scaphoid Shift Test , Watson Test II. Indication Suspected tubercle Suspected scapholunate instability III. Maneuver Images Locate tubercle Extensor carpi radialis at palmar crease Examiner holds pressure on tubercle Thumb on tubercle (volar) Index finger on dorsum behind Press while moving wrist from ulnar to radial deviation IV. Interpretation Pain at rest suggests tubercle Pain or clunk suggests scapholunate instability V. References Images: Related links to external sites (from Bing) These images

2015 FP Notebook

3. Provocative wrist tests and MRI are of limited diagnostic value for suspected wrist ligament injuries: a cross-sectional study. (PubMed)

compared to the reference standard of arthroscopy. In a subgroup of 55 participants, MRI findings were also compared to arthroscopy. The provocative tests were the scaphoid shift test (SS test), lunotriquetral test (LT test), midcarpal test (MC test), distal radioulnar joint test (DRUJ test), triangular fibrocartilage complex (TFCC) stress test (TFCC test), TFCC stress test with compression (TFCC comp test), and the gripping rotatory impaction test (GRIT).Most provocative tests and MRI findings were (...) Provocative wrist tests and MRI are of limited diagnostic value for suspected wrist ligament injuries: a cross-sectional study. What is the diagnostic value of provocative wrist tests and magnetic resonance imaging (MRI) for suspected wrist ligament injuries?Cross-sectional study.105 people presenting to hand clinics with wrist pain and suspected wrist ligament injuries were evaluated prospectively.The integrity of wrist ligaments was tested with seven provocative tests. The results were

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2011 Journal of physiotherapy

4. Fractures (non-complex): assessment and management

. It aims to improve practice so that people with fractures receive the care that they need without unnecessary tests and treatments. The guideline should be read alongside the NICE guidelines on major trauma, major trauma: service delivery, spinal injury and fractures (complex). Who is it for? Healthcare professionals and practitioners who provide care for people with fractures People with fractures, their families and carers Fractures (non-complex): assessment and management (NG38) © NICE 2018. All (...) rules to determine whether an X-ray is needed in people over 5 years with suspected ankle fractures. Imaging of scaphoid fr Imaging of scaphoid fractures actures 1.2.3 Consider MRI for first-line imaging in people with suspected scaphoid fractures following a thorough clinical examination. 1.3 Management in the emergency department Reduction of distal r Reduction of distal radius fr adius fractures actures 1.3.1 Consider intravenous regional anaesthesia (Bier's block) when reducing dorsally

2016 National Institute for Health and Clinical Excellence - Clinical Guidelines

5. Extremity imaging

Administrative Guidelines 6 Ordering of Multiple Studies 6 Simultaneous Ordering of Multiple Studies 6 Repeated Imaging 6 Pre-Test Requirements 7 History 7 Imaging of the Extremities 8 General Information/Overview 8 Scope 8 Technology Considerations 8 Definitions 8 Clinical Indications 10 Congenital and Developmental Conditions 10 Blount disease (Pediatric only) 10 Congenital anomalies of the lower extremity (Pediatric only) 10 Congenital anomalies of the upper extremity (Pediatric only) 11 Coxa vara (...) on persistent symptoms with no clinical change, treatment, or intervention since the previous study ? Repeated imaging of the same anatomical area by different providers for the same member over a short period of time Imaging of the Extremities Copyright © 2019. AIM Specialty Health. All Rights Reserved. 7 Pre-Test Requirements Critical to any finding of clinical appropriateness under the guidelines for specific imaging exams is a determination that the following are true with respect to the imaging request

2019 AIM Specialty Health

7. Imaging Program Guidelines: Pediatric Imaging

Bryn Mawr Avenue South Tower – Suite 800 Chicago, IL 60631 P . 773.864.4600 www.aimspecialtyhealth.comTable of Contents – Pediatrics | Copyright © 2017. AIM Specialty Health. All Rights Reserved. 2 Table of Contents Description and Application of the Guidelines 4 Administrative Guidelines 5 Ordering of Multiple Studies 5 Pre-test Requirements 6 Head & Neck Imaging 7 CT of the Head – Pediatrics 7 MRI of the Head/Brain – Pediatrics 14 CTA/MRA Head: Cerebrovascular – Pediatrics 21 Functional MRI (fMRI (...) of clinical appropriateness under the guidelines for specific imaging exams is a determination that the following are true with respect to the imaging request: ? A clinical evaluation has been performed prior to the imaging request (which should include a complete history and physical exam and review of results from relevant laboratory studies, prior imaging and supplementary testing) to identify suspected or established diseases or conditions. ? For suspected diseases or conditions: ? Based

2017 AIM Specialty Health

8. CRACKCast E051 – Wrist and Forearm Injuries

tenderness and swelling Detection may increase with radial OR ulnar deviation* Watson’s scaphoid shift test Axial compression of the 1st MC* Pain on thumb/index finger pinch Palpation of the scaphoid tubercle volarly* X-ray findings: 15% of plain radiographs immediately after the fall miss the injury Need to get scaphoid views to increase sensitivity Findings: Fracture lucency, obliteration of the scaphoid fat pad Optimal imaging? “Still controversial”, but definitely not bone scans CT: 93% sensitive (...) ROM Physical exam shows: Dorsal wrist pain – at the scapholunate ligament Watson’s scaphoid shift test producing clunks or snaps when moving the wrist from ulnar to radially Not useful acutely! Typically stages 2-4 have visible wrist deformities and median nerve sensory loss Figure 51-20 The LUNATE is the centre of attention The sequential stages of carpal instability – shows an intercarpal ligament injury proceeding from the scapholunate inter-space then distally to the capitate

2016 CandiEM

9. 4DCT Imaging for Improved Diagnosis and Treatment of Wrist Ligament Injuries

of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Information provided by (Responsible Party): Kristin Zhao, Mayo Clinic Study Details Study Description Go to Brief Summary: The study seeks to determine whether the 4DCT imaging technique can be used to replace current invasive diagnostic tests for ligament injuries of the wrist. Condition or disease Intervention/treatment Phase Scapholunate Interosseous Ligament Injury Device: 4DCT Not Applicable Detailed Description: Aim 1: 40 cadaveric forearm (...) actuator drives the grip back-and-forth along the x-axis with free-motion along the z-axis. The linear actuator will be programmed to allow the wrist to perform a full radial-ulnar or flexion-extension motion at 30 deg/sec which simulates in vivo wrist motion speeds. A motion cycle is approximately 2 seconds. The wrist will be cycled 100 times in flexion-extension prior to each testing condition. A static CT image will be acquired in the neutral posture. Then, each wrist will be imaged using 4DCT

2017 Clinical Trials

10. Articles of the Month (December 2016)

with Extremity Fractures Increase their Risk for Bone Healing Complications? The Journal of emergency medicine. 2016. PMID: This is a retrospective cohort of children aged 6 months to 17 years with fractures of the tibia, femur, humerus, scaphoid, or fifth metatarsal (chosen because these are bones with higher rates of healing complications). They identified 1192 children with these injuries, but 298 did not have follow up with their orthopedic service, so were excluded. 808 patients were included (...) , the medical culture is deeply against acknowledging or embracing it. Our quixotic quest for the right answer conceals the fact that ideal clinical reasoning is iterative and evolutionary. They point out that two of the major problems that we face in modern medicine – the seemingly contradictory over-testing and premature closure – are two sides of the same coin. They both arise out of our discomfort with and inability to discuss uncertainty. Bottom line: A quote: “Key elements for survival in the medical

2017 First10EM

11. Volar Plate vs. Conventus DRS Fixation

year after surgery at 2 weeks, 6 weeks, 3 months, and 1 year postoperatively. Radial inclination [ Time Frame: Up to 1 year ] Radial inclination will be assessed on x-rays at clinical follow-ups up to 1 year after surgery at 2 weeks, 6 weeks, 3 months, and 1 year postoperatively. Ulnar variance [ Time Frame: Up to 1 year ] Ulnar variance will be assessed on x-rays at clinical follow-ups up to 1 year after surgery at 2 weeks, 6 weeks, 3 months, and 1 year postoperatively. Coronal Shift [ Time Frame (...) : Up to 1 year ] Coronal shift will be assessed on x-rays at clinical follow-ups up to 1 year after surgery at 2 weeks, 6 weeks, 3 months, and 1 year postoperatively. Grip Strength [ Time Frame: Up to 1 year ] Grip strength will be measured by the PI of the study with a Jamar grip dynamometer at clinical follow-ups up to 1 year after surgery at 2 weeks, 6 weeks, 3 months, and 1 year postoperatively. Return to Work/Activities (quickDASH questionnaire) [ Time Frame: Up to 1 year ] The QuickDASH

2015 Clinical Trials

12. Isolated Lunocapitate Osteoarthritis—An Alternative Pattern of Osteoarthritis (PubMed)

the alternative pattern of OA, we compared demographic data, presentation, and physical and radiographic examination characteristics between the patients with lunocapitate OA and SLAC wrists. Fifteen radiographs showed OA, nine had a SLAC pattern, and six had lunocapitate OA. The demographics were similar, but the clinical presentation was different. The patients with lunocapitate OA had less tenderness over the snuffbox (P < 0.03), and a lower percentage of a positive scaphoid shift test (P <  0.005

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2014 Journal of wrist surgery

13. Carpal Ligament Instability (Diagnosis)

of the capitate and lunate. This joint, without other supporting structures, is stable only in tension. It is unstable in compression, as this figure depicts, and tends to collapse. The scaphoid acts like a bridge between the proximal and distal row and protects the link from collapsing. Mayfield perilunate instability pattern. Copyright Mayo Clinic, used with permission of the Mayo Foundation. (Click Image to enlarge.) Watson scaphoid shift test. (Click Image to enlarge.) Kleinman shear test. Reagan shuck (...) Jan. 7 (1):87-91. . Navarro A. Anales de Instituto de Clinica Quirurgica y Cirugia Experimental. Montevideo: Imprenta Artistica de Dornaleche Hnos. 1935. Gilford WW, Bolton RH, Lambrinudi C. The mechanism of the wrist joint with special reference to fractures of the scaphoid. Guy's Hospital Report . 1943. 92:52-59. Linscheid RL, Dobyns JH. Carpal instability. Curr Orthop . 1989. 3:106-114. Weber ER. Concepts governing the rotational shift of the intercalated segment of the carpus. Orthop Clin

2014 eMedicine Surgery

14. Evaluation of the Pediatric Surgical Patient (Diagnosis)

of the abdomen may also be a clue to guide diagnosis. A scaphoid abdomen in a neonate or infant may suggest a diaphragmatic hernia but may be normal in a thin child. Intestinal obstruction, an abdominal mass, or ascitic fluid may cause abdominal distention. Second, listen for bowel sounds. Be patient because up to 2 minutes may pass before bowel sounds are heard. The absence of bowel sounds may suggest peritonitis. The character of the bowel sounds is also important; high-pitched sounds are consistent (...) attention must be given to modesty during the genital examination. In addition, always ensure that a staff person of the same sex as the patient is present in the room during the examination. Genital examination in boys is necessary in the evaluation of a number of conditions, including hydroceles and undescended testes. The genital examination is one of the least comfortable parts of the physical examination; boys can assume the position most comfortable for them—lying down, sitting frog-legged

2014 eMedicine Pediatrics

15. Swan-Neck Deformity (Overview)

for deficient EPL function. To test for EPL tendon rupture, palpate the tendon at the wrist while the patient extends the thumb with the palm resting on a flat surface. Active testing may also reveal some weakness and pain at the site of rupture. Significant deformity or functional loss is an indication for repair by end-to-end repair, tendon graft, or to avoid flexion contraction. [ , ] Tendon transfer with the extensor indicis proprius or extensor carpi radialis longus is the preferred method (...) quinti function reduces small finger extension at the MP joint by 30-40°. Any greater loss usually indicates the extensor digiti communis tendon has also been affected. The lesion is a sign of loss of extension in the little and ring fingers due to rupture of these tendons at the distal ulnar head, which can result from caput ulna syndrome. Small finger extension can be tested by having the patient extend the small finger while the index, middle, and ring fingers are held in flexion. A small finger

2014 eMedicine Surgery

16. Ulnar-Sided Wrist Pain (Overview)

, followed by determination of the range of motion and palpation. Often, physicians delay palpation or movement of the wrist until the end of the examination. In that way, other disorders can be excluded systematically while the patient is still fully cooperative. Finally, special provocative tests (eg, triquetrolunate ballottement, ulnar ballottement, midcarpal shifting) can be performed to confirm the suspected pathology (see Provocative Maneuvers). Upon inspection, note any swelling, erythema (...) if the patient's pain is reproduced, suggesting triquetral chondromalacia or lunotriquetral injury. In addition, the examiner may wish to inject approximately 0.5 mL of lidocaine into the lunotriquetral joint to differentiate intra-articular from extra-articular pathology. Provocative testing for midcarpal shift To test for midcarpal instability on the right wrist, the examiner stabilizes the patient's forearm, with the left hand in a pronated position. [ ] With the patient's wrist in 15° of ulnar deviation

2014 eMedicine Surgery

17. Ulnar-Sided Wrist Pain (Diagnosis)

, followed by determination of the range of motion and palpation. Often, physicians delay palpation or movement of the wrist until the end of the examination. In that way, other disorders can be excluded systematically while the patient is still fully cooperative. Finally, special provocative tests (eg, triquetrolunate ballottement, ulnar ballottement, midcarpal shifting) can be performed to confirm the suspected pathology (see Provocative Maneuvers). Upon inspection, note any swelling, erythema (...) if the patient's pain is reproduced, suggesting triquetral chondromalacia or lunotriquetral injury. In addition, the examiner may wish to inject approximately 0.5 mL of lidocaine into the lunotriquetral joint to differentiate intra-articular from extra-articular pathology. Provocative testing for midcarpal shift To test for midcarpal instability on the right wrist, the examiner stabilizes the patient's forearm, with the left hand in a pronated position. [ ] With the patient's wrist in 15° of ulnar deviation

2014 eMedicine Surgery

18. Carpal Ligament Instability (Follow-up)

. The pivot point is at the center of rotation of the capitate and lunate. This joint, without other supporting structures, is stable only in tension. It is unstable in compression, as this figure depicts, and tends to collapse. The scaphoid acts like a bridge between the proximal and distal row and protects the link from collapsing. Mayfield perilunate instability pattern. Copyright Mayo Clinic, used with permission of the Mayo Foundation. (Click Image to enlarge.) Watson scaphoid shift test. (Click (...) governing the rotational shift of the intercalated segment of the carpus. Orthop Clin North Am . 1984 Apr. 15(2):193-207. . Craigen MA, Stanley JK. Wrist kinematics. Row, column or both?. J Hand Surg Br . 1995 Apr. 20 (2):165-70. . Garcia-Elias M, Ribe M, Rodriguez J, Cots M, Casas J. Influence of joint laxity on scaphoid kinematics. J Hand Surg Br . 1995 Jun. 20 (3):379-82. . Lichtman DM, Bruckner JD, Culp RW, Alexander CE. Palmar midcarpal instability: results of surgical reconstruction. J Hand Surg

2014 eMedicine Surgery

19. Swan-Neck Deformity (Diagnosis)

for deficient EPL function. To test for EPL tendon rupture, palpate the tendon at the wrist while the patient extends the thumb with the palm resting on a flat surface. Active testing may also reveal some weakness and pain at the site of rupture. Significant deformity or functional loss is an indication for repair by end-to-end repair, tendon graft, or to avoid flexion contraction. [ , ] Tendon transfer with the extensor indicis proprius or extensor carpi radialis longus is the preferred method (...) quinti function reduces small finger extension at the MP joint by 30-40°. Any greater loss usually indicates the extensor digiti communis tendon has also been affected. The lesion is a sign of loss of extension in the little and ring fingers due to rupture of these tendons at the distal ulnar head, which can result from caput ulna syndrome. Small finger extension can be tested by having the patient extend the small finger while the index, middle, and ring fingers are held in flexion. A small finger

2014 eMedicine Surgery

20. Prune Belly Syndrome (Overview)

Next: Indications Urethral obstruction should be addressed as soon as it is recognized. Progressive urethral dilation, as described by Passerini-Glazel et al, is the preferred method of treatment. Vesicostomy can also be an effective method of temporary diversion. The literature contains little controversy regarding management of undescended testes in these children. If controversy or confusion arises, it concerns the optimal timing for the orchidopexy and which type of orchidopexy should (...) with prune belly syndrome have megacystis. The bladder is routinely enlarged, although trabeculations are rarely present and muscular hypertrophy is inconsistent. The bladder can be fixed to the umbilicus via urachus, giving it an hourglass configuration radiographically. Bladder-voiding pressures are frequently near-normal, and residual urine volume is insignificant. Snyder et al describe a typical shift to the right, and some patients with prune belly syndrome can void normally. [ ] Some authors feel

2014 eMedicine.com

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