Jump to content

Scaphoid Shift Test

Original Editors- Rik Van der Hoeven Top Contributors - Rik Van der Hoeven, Simisola Ajeyalemi, Mmesoma Eyisi, Alexandra Stead, Laurien Henau, Kim Jackson, Matt Huey, Admin, George Prudden, Claire Knott and Wanda van Niekerk -Rik Van der Hoeven

Purpose

The Scaphoid Shift Test, alternatively known as the Watson Test, is a provocative manoeuvre used to diagnose scapholunate ligament (SLL) instability.[1] This test was first described by Dr. H. Kirk Watson, and it is used to examine the dynamic stability of the scaphoid to allow for a classification of the stage of instability to determine the proper treatment plan.[2][3] He stated that instability of the scaphoid can lead to degenerative changes in the wrist[4]. Besides checking for stability, the examiner will also be able to reflect the quality of the adjoining articular surfaces.[5]

Clinically Relevant Anatomy

Illustration of scapholunate ligament anatomy. The drawing depicts a slightly oblique, coronal view of the distal radius (R), scaphoid (S) and lunate (L). The scapholunate ligament has been transected to demonstrate its three distinct parts, which include the dorsal region (arrowhead), palmar region (white arrow) and proximal region (black arrow) components. Note that the dorsal component is the thickest.

The ligaments thought to provide the principal support to the scaphoid are the radioscaphocapitate ligament, the scaphoid-trapezoid-trapezium ligament, and the scapholunate ligament.[6][7]
The scapholunate ligament (SLL) is the link between the carpal scaphoid and lunate bone. It ensures the stability of the scapholunate joint and helps stabilise the entire wrist.[8]

The scapholunate ligament is an intra-articular structure (i.e., synovial) composed of three regions:[3][9]

  • Dorsal ligament: transversely oriented collagen fibres providing primary restraint for distraction and torsional/translational movements
  • Palmar ligament: provides rotational stability
  • Proximal fibrocartilage: negligible contribution to restraint of abnormal motion

Technique

The scaphoid shift test is performed with the patient seated and the examiner either seated standing. The following steps outline the procedure:

  • The patient should rest their arm with their elbow on the table and forearm lifted and the hand slightly pronated.
  • With one hand, the examiner fixates the radius whilst placing pressure through their own thumb on the palmar side of the scaphoid (on the scaphoid tubercle).[2][10]
  • With the other hand, using the patients metacarpals, place the patients hand into ulnar deviation and in slight extension. At this point, the scaphoid lies almost 'in line' with the radius.
  • From this position the hand is moved passively by the examiner into radial deviation and slight palmar flexion, whilst keeping pressure on the scaphoid.
  • During this movement, the distal part of the scaphoid tilts forward and thereby pushes against the examiner's thumb (which is pushing in the opposite direction) causing stress on the joints.[2][6][11]
  • In case of a SL ligament rupture or laxity, the scaphoid will shift/ displace dorsally in relation to the other carpal bones in the wrist
  • When the thumb force is then abruptly taken away, the shift will be reduced and the scaphoid will fall back in its normal position, which may result in a painful 'thunk'.[2] [10][11]
  • This test should be performed on both wrists as a comparison.


Interpretation

Positive test: A palpable and/or audible reduction of the subluxed scaphoid and elicitation of symptomatic pain, typically on the dorsal side.[2][3]

Negative test: The scaphoid moves normally, pushing against the examiner's thumb and there is no symptomatic pain.

Watson has described this test more as a provocation then a test with a positive and negative result.[2] An experienced examiner may be able to conclude a variety of findings from this test, though caution should be given to increased mobility, which may be as a result of hypermobility syndrome, though this is likely to be apparent bilaterally.[12] Similarly, pain that is less localised combined with normal, limited or 'gritty' movement may suggest more towards periscaphoid arthritis or scapho-lunate advanced collapse pattern. [2][10]

In suspected cases of SL instability, a static radiography and dynamic fluoroscopy are often recommended to provide information about the injury.[13] [8] The gold standard for detection of SLL injuries is an arthroscopy of the wrist, with confirmed findings classified using the Geissler classification grading system.[1] [8]

Evidence

The Scaphoid shift test has a low diagnostic value for SLL lesion, with a sensitivity of 50%, though this increased to 61% for those specifically referred with SLL instability, with a specificity was 62%.[1] As a result of relatively low diagnostic value, the scaphoid shift test should be interpreted with caution, with more importance placed on the patient's history, pain and feel of the movement, then the actual shift of the scaphoid.

When the Scaphoid test is performed with solography, it was found to be highly reliable to diagnose scapholunate lesions[14]. It was found that there was a statistically significant difference between the amount of dorsal subluxation between health (0.89m, SD 0.67mm) and pathological wrists (1.67mm, SD 0.95mm).

Clinical Implications

The Scaphoid Shift Test should be interpreted as part of a comprehensive wrist assessment rather than as a standalone diagnostic tool. Clinicians must carefully distinguish between physiological laxity and pathological instability by considering the presence and location of pain, the patient's clinical history, mechanism of injury, and functional limitations. A positive test in isolation, particularly if painless or bilateral, may simply reflect normal anatomical variation or generalised joint hypermobility rather than scapholunate ligament pathology. When the test reproduces the patient's dorsal wrist pain and demonstrates abnormal scaphoid movement, further investigation with imaging is warranted, given the test's moderate sensitivity and the complexity of wrist biomechanics.

References

  1. ↑ 1.0 1.1 1.2 Schmauss D, Pöhlmann S, Weinzierl A, Schmauss V, Moog P, Germann G, Bickert B, Megerle K. Relevance of the scaphoid shift test for the investigation of scapholunate ligament injuries. Journal of Clinical Medicine. 2022 Oct 26;11(21):6322.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 Watson HK, Ashmead D 4th, Makhlouf MV. Examination of the scaphoid. Journal of Hand Surg American Version. 1988 Sep;13(5):657-60
  3. ↑ 3.0 3.1 3.2 Kitay A, Wolfe SW. Scapholunate instability: current concepts in diagnosis and management. Journal Hand Surgery (American Volume) 2012;37(10):2175-96.
  4. ↑ Watson HK, Ryu J, Akelman E. Limited triscaphoid intercarpal arthrodesis for rotatory subluxation of the scaphoid. J Bone Joint Surg Am. 1986;68(3):345-349.
  5. ↑ Easterling KJ, Wolfe SW. Scaphoid shift in the uninjured wrist. Journal of Hand Surgery Am. 1994 Jul-Aug;19(4):604-606.
  6. ↑ 6.0 6.1 Wozasek GE, Laske H. The ligaments of the scaphoid bone. Handchir Mikrochir Plast Chir. 1991;23(1):18-22.
  7. ↑ Berger R. A. (1997). The ligaments of the wrist. A current overview of anatomy with considerations of their potential functions. Hand clinics, 13(1), 63–82.
  8. ↑ 8.0 8.1 8.2 Zhou, J. Y., Jodah, R., Joseph, L. P., & Yao, J. (2024). Scapholunate Ligament Injuries. Journal of hand surgery global online, 6(3), 245–267. https://doi.org/10.1016/j.jhsg.2024.01.015
  9. ↑ Pappou IP, Basel J, Deal DN. Scapholunate ligament injuries: a review of current concepts. Hand (N Y). 2013 Jun;8(2):146-56. 
  10. ↑ 10.0 10.1 10.2 Gleeson AP, Brookes C, Brydon G. Scapholunate instability--a spectrum of pathology. J Accid Emerg Med. 1996 May;13(3):216-9.
  11. ↑ 11.0 11.1 Wolfe SW, Crisco JJ. Mechanical evaluation of the scaphoid shift test. J Hand Surg Am 1994 Sep;19(5):762-8.
  12. ↑ Watson, H., Ottoni, L., Pitts, E. C., & Handal, A. G. (1993). Rotary subluxation of the scaphoid: a spectrum of instability. Journal of hand surgery (Edinburgh, Scotland), 18(1), 62–64. https://doi.org/10.1016/0266-7681(93)90199-p
  13. ↑ Park MJ. Radiographic observation of the scaphoid shift test. J Bone Joint Surg Br. 2003 Apr;85(3):358-62.
  14. ↑ Huber N, Götschi T, Schweizer A, Reissner L. Catch the shift: Ultrasound diagnosis of scapholunate lesion during Watson test. Hand Surg Rehabil. 2024;43(5):101756. doi:10.1016/j.hansur.2024.101756
Retrieved from "https://www.physio-pedia.com/w/index.php?title=Scaphoid_Shift_Test&oldid=375083"