Reliability of Provocative Maneuvers for Hand Pathologies: Concordance Between Nonspecialist and Specialist Assessments in a General Clinic Setting

Abstract

Purpose

Provocative maneuvers are frequently employed by hand surgeons to evaluate common hand pathologies. Although prior studies have evaluated the efficacy of individual maneuvers independently, to date, no studies have been performed evaluating the concordance between nonsurgeon-administered Tinel, Eichhoff, Finkelstein, and carpometacarpal Grind test and attending hand surgeon diagnoses in a general hand clinic population.

Methods

A prospective cohort study was performed on new patients presenting to the hand clinic. All four provocative maneuvers were performed on each patient. Positive versus negative results were recorded by a student and compared with the final clinical diagnoses by fellowship-trained, board-certified hand surgeons retrospectively. Descriptive statistics and χ² analysis were performed.

Results

A total of 93 patients were enrolled in the study. The concordance between the nonsurgeon examination and the hand surgeon examination was analyzed. Analyses showed that Tinel test, Grind test, and Eichhoff test were meaningfully associated with their respective hand pathologies, whereas Finkelstein test was not. Among the tests evaluated, the Grind test showed the greatest concordance, and the Tinel test offered high concordance while also limiting false-positive examinations, even between a nonsurgeon and a hand specialist.

Conclusions

This prospective study revealed varied concordance among maneuvers. The Grind test, Tinel test, and Eichhoff test demonstrated efficacy in identifying carpometacarpal arthritis, carpal tunnel syndrome, and de Quervain tenosynovitis, respectively. Although these tests were not designed for screening, these maneuvers may support early hypothesis generation when evaluating undifferentiated upper-extremity complaints in the clinic.

Type of study/level of evidence

Diagnostic IIb.