Execution
- 1Position the patient sitting across from the examiner with the elbow flexed to 90° and the forearm in neutral.
- 2Support the ulnar side of the hand to maintain a neutral wrist and prevent ulnar deviation.
- 3Place the other thumb along the radial aspect of the distal thumb metacarpal, about 5 to 10 mm proximal to the MCP joint.
- 4Firmly extend the thumb until the metacarpal lies parallel to the palm or a firm end feel is reached.
- 5Record whether pain is reproduced at the TMC / CMC joint.
Positive outcome
Reproduction of pain at the thumb CMC joint during firm extension stress is positive. The pain should localize to the basal thumb region. This is not the same as isolated thumb MCP extension pain.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Gelberman et al. (2015) | κ = 0.84 reported for provocation tests | 94 | 95 | 18.8 | 0.06 |
CommentGelberman’s study reported excellent sensitivity and specificity for the extension provocative test, but it was a novel clinical test needing broader validation. This test is not found as a main Magee procedure in the retrieved chapter text. Use the same pain-localization discipline as other thumb CMC provocation tests.
High Clinical Value