Execution
- 1Position the patient sitting with the elbow resting on the table and the forearm pronated.
- 2First test the unaffected wrist for comparison.
- 3Place one hand on the metacarpals and move the wrist into full ulnar deviation with slight extension.
- 4Press the thumb of the other hand on the palmar scaphoid tubercle while counterpressure is applied dorsally.
- 5Radially deviate and slightly flexes the wrist while maintaining pressure on the scaphoid tubercle.
Positive outcome
Pain with dorsal scaphoid subluxation or a painful shift over the dorsal rim of the radius is positive. A thunk when pressure is released may occur as the scaphoid returns to normal position. Magee cautions that a painless clunk may be normal in hypermobile wrists, while pain without thunk can occur with scaphoid fracture.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Watson et al. (1988) | NA | NA | NA | NA | NA |
| Lane (1993) | NA | NA | NA | NA | NA |
| Wolfe & Crisco (1994) — mechanical evaluation | NA | NA | NA | NA | NA |
CommentMagee emphasizes comparison with the unaffected side and correct thumb placement on the scaphoid tubercle. This is a classic provocative instability manoeuvre, but diagnostic accuracy is not robust and examiner skill matters. Avoid overcalling painless clunking in generalized hypermobility.
Low Clinical Value