刺激手法对手部疾病的可靠性：在普通诊所设置非专科和专科评估之间的一致性

Q3 Medicine

Journal of Hand Surgery Global Online Pub Date : 2025-09-19 DOI:10.1016/j.jhsg.2025.100824

Clay B. Thames BA , Evan Bowen BS , Greg Vance BE , Bradley Hathaway BA , Kacy Benedict MD , Mark Dodson MD , Marc Walker MD

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引用次数: 0

摘要

目的手外科医生经常使用挑衅性动作来评估常见的手部病变。虽然先前的研究已经独立评估了个体操作的有效性，但迄今为止，还没有研究评估非手术治疗的Tinel， Eichhoff， Finkelstein和carpometacarpal Grind测试与一般手部门诊人群的主治手外科医生诊断之间的一致性。方法采用前瞻性队列研究对初诊手部门诊的患者进行分析。所有四种刺激动作都在每位患者身上进行。阳性和阴性结果由一名学生记录下来，并与最终临床诊断结果进行回顾性比较。进行描述性统计和χ2分析。结果共纳入93例患者。分析了非外科检查与手外科检查的一致性。分析显示，Tinel检验、Grind检验和Eichhoff检验与各自的手部病理有显著相关，而Finkelstein检验则无显著相关。在评估的测试中，Grind测试显示出最大的一致性，而Tinel测试提供了高一致性，同时也限制了假阳性检查，即使在非外科医生和手部专家之间也是如此。结论本前瞻性研究揭示了不同动作之间的一致性。Grind试验、Tinel试验和Eichhoff试验分别证明了识别腕掌关节炎、腕管综合征和de Quervain腱鞘炎的有效性。虽然这些测试不是为筛查而设计的，但这些操作可以在临床评估未分化上肢疾患时支持早期假设生成。研究类型/证据水平

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

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.