Watson's test

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Watson's test is a diagnostic test for instability between the scaphoid and lunate bones of the wrist.

Medical diagnosis process to determine or identify a disease or disorder

Medical diagnosis is the process of determining which disease or condition explains a person's symptoms and signs. It is most often referred to as diagnosis with the medical context being implicit. The information required for diagnosis is typically collected from a history and physical examination of the person seeking medical care. Often, one or more diagnostic procedures, such as medical tests, are also done during the process. Sometimes posthumous diagnosis is considered a kind of medical diagnosis.

Lunate bone bone of the carpus

The lunate bone is a carpal bone in the human hand. It is distinguished by its deep concavity and crescentic outline. It is situated in the center of the proximal row carpal bones, which lie between the ulna and radius and the hand. The lunate carpal bone is situated between the lateral scaphoid bone and medial triquetral bone.

Wrist part of the arm between the lower arm and the hand

In human anatomy, the wrist is variously defined as 1) the carpus or carpal bones, the complex of eight bones forming the proximal skeletal segment of the hand; (2) the wrist joint or radiocarpal joint, the joint between the radius and the carpus and (3) the anatomical region surrounding the carpus including the distal parts of the bones of the forearm and the proximal parts of the metacarpus or five metacarpal bones and the series of joints between these bones, thus referred to as wrist joints. This region also includes the carpal tunnel, the anatomical snuff box, bracelet lines, the flexor retinaculum, and the extensor retinaculum.

Contents

Test procedure

To perform the test, the examiner grasps the wrist with their thumb over the scaphoid tubercle (volar aspect of the palm) in order to prevent the scaphoid from moving into its more vertically oriented position in radial deviation. For the test, the wrist needs to be in slight extension. The patient's wrist is then moved from ulnar to radial deviation. The examiner will feel a significant 'clunk' and the patient will experience pain if the test is positive. For completeness, the test must be performed on both wrists for comparison. If the scapholunate ligament is disrupted, the scaphoid will subluxate over the dorsal lip of the distal radius.

Ulnar deviation

Ulnar deviation, also known as ulnar drift, is a hand deformity in which the swelling of the metacarpophalangeal joints causes the fingers to become displaced, tending towards the little finger. Its name comes from the displacement toward the ulna. Ulnar deviation is likely to be a characteristic of rheumatoid arthritis, more than of osteoarthritis. Consideration should also be given to pigmented villonodular synovitis, in the setting of ulnar deviation and metacarpophalangeal synovitis.

Scapholunate ligament

The scapholunate ligament is a ligament of the wrist.

Original Description by Watson:

"The patient is approached by the examiner as if to engage in arm wrestling, face to face across a table with diagonally opposed hands raised (right to right or left to left) and elbows resting on the surface in between. With the patient's forearm slightly pronated, the examiner grasps the wrist from the radial side, placing his thumb on the scaphoid tuberosity (as if pushing a button to open a car door) and wrapping his fingers around the distal radius. The examiner's other hand grasps at the metacarpal level, controlling the wrist position. Starting in ulnar deviation and slight extension, the wrist is moved radially and slightly flexed with constant thumb pressure on the scaphoid. This radial deviation causes the scaphoid to flex. The examiners thumb pressure opposes this normal rotation, causing the scaphoid to shift in relation to the other bones of the carpus. This scaphoid shift may be subtle or dramatic. A truly positive test requires both pain on the back of the wrist (not just where you are pressing on the scaphoid tuberosity), and comparison with the opposite wrist is essential."

Uses

Watson's test is used by physicians to diagnose scapholunate instability. This test has a low specificity and sometimes is positive for capito-lunate instability. As many as 20% of normal wrists will also have a 'clunk'.

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See also

Carpal bones bone

The carpal bones are the eight small bones that make up the wrist that connects the hand to the forearm. The term "carpus" is derived from the Latin carpus and the Greek καρπός (karpós), meaning "wrist". In human anatomy, the main role of the wrist is to facilitate effective positioning of the hand and powerful use of the extensors and flexors of the forearm, and the mobility of individual carpal bones increase the freedom of movements at the wrist.

Orthopedic surgery medical specialty concerned with the human apparatus of movement

Orthopedic surgery or orthopedics, also spelled orthopaedics, is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors, and congenital disorders.

Related Research Articles

Anatomical snuffbox

The anatomical snuff box or snuffbox is a triangular deepening on the radial, dorsal aspect of the hand—at the level of the carpal bones, specifically, the scaphoid and trapezium bones forming the floor. The name originates from the use of this surface for placing and then sniffing powdered tobacco, or "snuff." It is sometimes referred to by its French name tabatière.

The forearm is the region of the upper limb between the elbow and the wrist. The term forearm is used in anatomy to distinguish it from the arm, a word which is most often used to describe the entire appendage of the upper limb, but which in anatomy, technically, means only the region of the upper arm, whereas the lower "arm" is called the forearm. It is homologous to the region of the leg that lies between the knee and the ankle joints, the crus.

Trapezium (bone) bone of the wrist

The trapezium bone is a carpal bone in the hand. It forms the radial border of the carpal tunnel.

Scaphoid bone bone of the carpus

The scaphoid bone is one of the carpal bones of the wrist. It is situated between the hand and forearm on the thumb side of the wrist. It forms the radial border of the carpal tunnel. The scaphoid bone is the largest bone of the proximal row of wrist bones, its long axis being from above downward, lateralward, and forward. It is approximately the size and shape of a medium cashew.

Capitate bone bone of the wrist

The capitate bone is found in the center of the carpal bone region, colloquially known as the wrist, which is at the distal end of the radius and ulna bones. It articulates with the third metacarpal bone and forms the third carpometacarpal joint. The capitate bone is the largest of the carpal bones in the human hand. It presents, above, a rounded portion or head, which is received into the concavity formed by the scaphoid and lunate bones; a constricted portion or neck; and below this, the body. The bone is also found in many other mammals, and is homologous with the "third distal carpal" of reptiles and amphibians.

Hamate bone bone of the wrist

The hamate bone or unciform bone is a bone in the human wrist readily distinguishable by its wedge shape and a hook-like process ("hamulus") projecting from its palmar surface.

Radius (bone) one of the two long bones of the forearm

The radius or radial bone is one of the two large bones of the forearm, the other being the ulna. It extends from the lateral side of the elbow to the thumb side of the wrist and runs parallel to the ulna. The radius is shorter and smaller than the ulna. It is a long bone, prism-shaped and slightly curved longitudinally.

Distal radius fracture frykman VII

A distal radius fracture, also known as wrist fracture, is a break of the part of the radius bone which is close to the wrist. Symptoms include pain, bruising, and rapid-onset swelling. The wrist may be deformed. The ulna bone may also be broken.

Kienböcks disease Kienbock disease is a rare bone disorder of unknown etiology characterized clinically by osteonecrosis of the carpal lunate, eventually leading to collapse of the lunate bone impacting wrist function

Kienböck's disease is a disorder of the wrist. It is named for Dr. Robert Kienböck, a radiologist in Vienna, Austria who described osteomalacia of the lunate in 1910.

Finkelsteins test


Finkelstein's test is a test used to diagnose de Quervain's tenosynovitis in people who have wrist pain.

Madelungs deformity Madelung disease, or deformity (MD) is a predominantly bilateral wrist anomaly characterized by shortened and bowed radii and long ulnae leading to dorsal dislocation of the distal ulna and limited mobility of the wrist and elbow

Madelung's deformity is usually characterized by malformed wrists and wrist bones and is often associated with Léri-Weill dyschondrosteosis. It can be bilateral or just in the one wrist. It has only been recognized within the past hundred years. Named after Otto Wilhelm Madelung (1846-1926), a German surgeon, who described it in detail, it was noted by others. Guillaume Dupuytren mentioned it in 1834, Auguste Nélaton in 1847, and Joseph-François Malgaigne in 1855.

Triangular fibrocartilage

The Triangular fibrocartilage complex (TFCC) is formed by the triangular fibrocartilage discus (TFC), the radioulnar ligaments (RULs) and the ulnocarpal ligaments (UCLs).

Midcarpal joint

The midcarpal joint is formed by the scaphoid, lunate, and triquetral bones in the proximal row, and the trapezium, trapezoid, capitate, and hamate bones in the distal row. The distal pole of the scaphoid articulates with two trapezial bones as a gliding type of joint. The proximal end of the scaphoid combines with the lunate and triquetrum to form a deep concavity that articulates with the convexity of the combined capitate and hamate in a form of diarthrodial, almost condyloid joint.

Scaphoid fracture

A scaphoid fracture is a break of the scaphoid bone in the wrist. Symptoms generally includes pain at the base of the thumb which is worse with use of the hand. The anatomic snuffbox is generally tender and swelling may occur. Complications may include nonunion of the fracture, avascular necrosis, and arthritis.

Radial dysplasia Radial hemimelia is a congenital longitudinal deficiency of the radius bone of the forearm characterized by partial or total absence of the radius

Radial dysplasia, also known as radial club hand or radial longitudinal deficiency, is a congenital difference occurring in a longitudinal direction resulting in radial deviation of the wrist and shortening of the forearm. It can occur in different ways, from a minor anomaly to complete absence of the radius, radial side of the carpal bones and thumb. Hypoplasia of the distal humerus may be present as well and can lead to stiffness of the elbow. Radial deviation of the wrist is caused by lack of support to the carpus, radial deviation may be reinforced if forearm muscles are functioning poorly or have abnormal insertions. Although radial longitudinal deficiency is often bilateral, the extent of involvement is most often asymmetric.

Wrist osteoarthritis

Wrist osteoarthritis is a group of mechanical abnormalities resulting in joint destruction, which can occur in the wrist. These abnormalities include degeneration of cartilage and hypertrophic bone changes, which can lead to pain, swelling and loss of function. Osteoarthritis of the wrist is one of the most common conditions seen by hand surgeons.

References

  1. H. Kirk Watson, et al.; 1988; Examination of the scaphoid; Journal of Hand Surgery, volume: 13A, 657-60.
  2. Forman, T.; Forman, S. & Rose, N. (1 November 2005), "A clinical approach to diagnosing wrist pain" , American Family Physician, 72 (9): 1753–8, PMID   16300037
  3. Nagle, D. (2000), "Evaluation of chronic wrist pain" , The Journal of the American Academy of Orthopaedic Surgeons, 8 (1): 45–55, PMID   10666652

This article uses text from the Watson's test article on WikiDoc.