Lunotriquetral grind test

Lunotriquetral pathology

Examiner stabilizes hand and wrist with one hand and uses the other thumb to push the ulnar side of the radially toward the lunate

Pain

Shuck test

Lunotriquetral stability

Examiner’s thumb on pisiform and fingers on dorsal lunate, deviation of wrist radially and ulnarly; or the pisiform and triquetrum are stabilized with one hand while the other shucks the medial carpus back and forth in a dorsoplamer direction.

Pain on dorsal aspect of the wrist at the lunate or lunotriquetral interval

Lunotriquetral ballottement or shear

Lunotriquetral stability and inflammation

As for scapholunate ballottement but with the lunate in one hand and the pisiform/triquetrum in the other; the bones are translated with respect to one another

Pain and/or instability at the lunotriquetral interval

Pisotriquetral shear test

Pisotriquetral stability

Examiner’s thumb is hooked on radial aspect of pisiform and it is pulled toward the ulna

Pain or instability

Pisotriquetral grind

Pisotriquetral joint synovitis or arthritis

Examiner’s thumb on pisiform and fingers of same hand on dorsal triquetrum, and joint is compressed

Pain or crepitus with compression

TFCC load and shear test

TFCC

Examiner grasps distal radius and ulna in one hand and metacarpals in the other; wrist is ulnarly deviated, then flexed and extended

Pain with ulnar deviation = positive load test

Pain and snapping with flexion and extension = positive stress test

ECU instability

ECU instability

Examiner grasps distal radioulnar area and palpates the ECU in its groove on the dorsal ulna; forearm is then pronated and supinated; track of the ECU is palpated and a finger is used to hook it just distal to the ulnar head; ECU is then stressed in various angles of pronation and supination

Instability of ECU from the normal confines of the groove

Piano key test

TFCC instability with palmar sag of the carpus relative to the ulna

Patient’s hand is placed palm down on table and attempts to force pisiform onto the table

Distal ulna shifts from slightly dorsal downward toward the table; must compare with contralateral for normal

DRUJ ballottement or shear test

DRUJ stability and arthritis

Examiner grasps distal ulna in one hand and the distal radius in the other; the forearm is then pronated and supinated and the radius and ulna are translated on each other in various positions

Instability, pain, and/or crepitus; must compare with contralateral side for normal

DRUJ grind test

DRUJ synovitis or arthritis

Examiner squeezes middle third of forearm to compress ulnar head into sigmoid notch and forearm is slightly rotated

Pain and crepitus