title: Provocative wrist tests and MRI are of limited diagnostic value for suspected wrist ligament injuries: a cross-sectional study.
abstract: OBJECTIVE
  What is the diagnostic value of provocative wrist tests and magnetic resonance imaging (MRI) for suspected wrist ligament injuries?
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  105 people presenting to hand clinics with wrist pain and suspected wrist ligament injuries were evaluated prospectively.
  
  
  METHODS
  The integrity of wrist ligaments was tested with seven provocative tests. The results were compared to the reference standard of arthroscopy. In a subgroup of 55 participants, MRI findings were also compared to arthroscopy. The provocative tests were the scaphoid shift test (SS test), lunotriquetral test (LT test), midcarpal test (MC test), distal radioulnar joint test (DRUJ test), triangular fibrocartilage complex (TFCC) stress test (TFCC test), TFCC stress test with compression (TFCC comp test), and the gripping rotatory impaction test (GRIT).
  
  
  RESULTS
  Most provocative tests and MRI findings were of little or no value for diagnosing wrist ligament injuries. Exceptions were the SS test (+ve LR 2.88 and -ve LR 0.28), MC test (+ve LR 2.67) and DRUJ test (-ve LR 0.30), all of which were of mild diagnostic usefulness. MRI was moderately useful for diagnosing TFCC injuries (+ve LR 5.56, -ve LR 0.15), and was mildly useful for diagnosing scapholunate (SL) ligament injuries (+ve LR 4.17, -ve LR 0.32) and lunate cartilage damage (+ve LR 3.67, -ve LR 0.33). Adding MRI to provocative tests improved the accuracy of diagnosis of TFCC injuries slightly (by 13%) and lunate cartilage damage (by 8%).
  
  
  CONCLUSIONS
  Provocative wrist tests of SL ligament injuries and midcarpal ligament injuries are mildly useful for diagnosing wrist injuries. MRI diagnostic findings of SL ligament injuries, lunate cartilage damage, and TFCC are mildly to moderately useful. MRI slightly improves the diagnosis of TFCC injury and lunate cartilage damage compared to provocative tests alone.
authors.affiliation: Sydney Hand Therapy and Rehabilitation Centre, Australia. rosemary_hands@msn.com.au
authors.forename: Rosemary
authors.initials: R
authors.lastname: Prosser
authors.forename: Lisa
authors.initials: L
authors.lastname: Harvey
authors.forename: Paul
authors.initials: P
authors.lastname: Lastayo
authors.forename: Ian
authors.initials: I
authors.lastname: Hargreaves
authors.forename: Peter
authors.initials: P
authors.lastname: Scougall
authors.forename: Robert D
authors.initials: RD
authors.lastname: Herbert
mesh_terms: D000328:Adult; D001182:Arthroscopy / Q000592:standards; D003430:Cross-Sectional Studies; D006801:Humans; D008022:Ligaments / Q000293:injuries* / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000592:standards*; D008875:Middle Aged; D026741:Physical Therapy Modalities; D014954:Wrist Injuries / Q000175:diagnosis* / Q000534:rehabilitation*