Grind Test | CMC 1 Osteoarthritis

Physiotutors

23 Jan 202303:21

Summary

TLDRThis video demonstrates the grind test for diagnosing carpal metacarpal osteoarthritis (CMC OA). It discusses thumb osteoarthritis, its prevalence, symptoms, and diagnostic methods. The grind test, which involves rotating the thumb metacarpal while applying pressure, has a 64% sensitivity and 100% specificity for CMC OA. The video emphasizes that CMC OA diagnosis relies on clinical assessment and radiographic imaging may not always correlate with symptoms. Viewers are encouraged to check out the Upper Limb Focus course on the wrist and hand for more detailed information.

Takeaways

👨‍⚕️ The video demonstrates the grind test for carpal metacarpal osteoarthritis, a condition that affects a large proportion of adults.
📈 Radiographic prevalence of thumb osteoarthritis reaches 90 percent in both men and women by age 80, indicating its widespread nature.
😖 This condition can cause pain at the base of the thumb, progressive loss of motion, weakness, and decreased coordination, which worsens over time.
🔍 Diagnosis involves qualitative assessment of history, physical examination, and radiographs, with the grind test being a key diagnostic tool.
📚 A 2017 study by Saliental compared four provocative tests and found the grind test to have a sensitivity of 64 percent and a specificity of 100 percent.
🚫 A negative grind test does not necessarily imply the absence of radiographic evidence of osteoarthritis, as clinical diagnosis is still required.
👨‍🏫 To conduct the grind test, the patient sits with their hand on a stable surface, and the examiner stabilizes the wrist while applying axial pressure on the trapezium.
✅ A positive grind test is indicated by the patient reporting pain or sensations like crepitus in the thumb's basal joint region.
📚 The video promotes an Upper Limb Focus course for further learning about wrist and hand diagnosis and treatment.
👍 The video encourages viewers to like, subscribe, and visit the physiotutors.com website for more educational content.
👋 The video concludes with a thank you from the presenter and an invitation to see viewers in the next video.

Q & A

What is the purpose of the video?
-The purpose of the video is to demonstrate the grind test for carpal metacarpal osteoarthritis and to provide information on diagnosing and treating this condition.
What is thumb osteoarthritis and why is it significant?
-Thumb osteoarthritis is a painful and debilitating condition that affects a large proportion of the adult population, with radiographic prevalence reaching 90 percent in both men and women by the age of 80. It is significant because it can cause pain, progressive loss of thumb motion, weakness, and decreased coordination.
What are the factors considered in the qualitative assessment for diagnosing thumb CMC arthritis?
-The factors considered include the location, duration, onset, frequency, intensity, and quality of the pain.
What study did Saliental conduct in 2017 and what was its purpose?
-Saliental conducted a comparative study in 2017 to determine the best diagnostic tests for thumb CMC osteoarthritis by comparing the results of four provocative tests with the Eden-Littler classification system of radiologic evaluation of the CMC joint.
What were the results of Saliental's study regarding the grind test's sensitivity and specificity?
-In Saliental's study, the grind test yielded a sensitivity of 64 percent and a specificity of 100 percent.
What does a positive grind test indicate for a patient?
-A positive grind test indicates the presence of CMC osteoarthritis, as it confirms the diagnosis and may distinguish those who do not have it.
What is the clinical value of the grind test according to the video?
-The grind test has moderate clinical value as it helps in diagnosing CMC osteoarthritis, but a negative test does not necessarily imply the absence of radiographic evidence of the condition.
How is the grind test conducted during an examination?
-The test is conducted with the patient in a sitting position, with the hand placed on a stable surface. The examiner stabilizes the patient's hand and wrist with one hand and grasps the thumb metacarpal with the other, rotating it while applying axial pressure on the trapezium.
What is considered a positive result for the grind test?
-The grind test is considered positive if the patient reports any pain, even a slight painful sensation, or other sensations such as crepitus in the basal joint region of the thumb.
What additional resources are offered by Physiotutors for learning more about wrist and hand conditions?
-Physiotutors offers an Upper Limb Focus course on the wrist and hand, taught by experts Thomas Mitchell and Andrew Cuff, which provides more information on diagnosis and treatment of various conditions in that area.
How can viewers access more content from Physiotutors?
-Viewers can access more content by visiting Physiotutors' website at visitutors.com, subscribing to their YouTube channel, or checking the video description for links to online courses.

Outlines

00:00

🤕 Introduction to the Grind Test for Thumb Osteoarthritis

This paragraph introduces a video by physiotutors that demonstrates the grind test for diagnosing carpal metacarpal osteoarthritis. The condition is described as painful and debilitating, affecting a significant portion of the adult population, with a high radiographic prevalence by age 80. The video aims to assess the history, physical examination, and radiographs for diagnosing thumb CMC arthritis, and emphasizes the importance of considering the pain's characteristics. A comparative study by Saliental in 2017 is mentioned, which evaluated the effectiveness of different diagnostic tests, highlighting the grind test's sensitivity and specificity. The paragraph concludes by explaining the clinical value of the grind test and its role in confirming the diagnosis of CMC osteoarthritis, while noting that radiographic evidence does not always correlate with pain or disability.

Mindmap

Keywords

💡Carpal Metacarpal Osteoarthritis

Carpal Metacarpal Osteoarthritis refers to a degenerative joint disease affecting the thumb's carpometacarpal joint. It is characterized by pain, progressive loss of motion, and decreased coordination in the thumb. In the video, this condition is the central focus, with the grind test being demonstrated as a diagnostic method for this specific type of osteoarthritis.

💡Grind Test

The grind test is a clinical examination technique used to assess for osteoarthritis in the thumb's joint. It involves rotating the thumb metacarpal while applying axial pressure, which, if positive, elicits pain or a grating sensation due to the degeneration of the joint. The test is highlighted in the video as a way to confirm the diagnosis of CMC osteoarthritis.

💡Sensitivity and Specificity

In medical testing, sensitivity refers to the proportion of true positive results among the patients who actually have the condition, while specificity is the proportion of true negative results among those who do not have the condition. The video mentions that the grind test has a sensitivity of 64 percent and a specificity of 100 percent, indicating that it is highly accurate in identifying those without the condition but less reliable in identifying those with milder forms of it.

💡Radiographic Prevalence

Radiographic prevalence denotes the proportion of a population that shows signs of a disease when examined using radiographic imaging. The video script states that radiographic prevalence of thumb osteoarthritis reaches 90 percent in both men and women by the age of 80, emphasizing the commonality of this condition in the elderly population.

💡Qualitative Assessment

Qualitative assessment in the medical context involves evaluating the nature of symptoms and signs rather than quantifying them. The video discusses the importance of considering various aspects of pain, such as its location, duration, and quality, in the diagnosis and treatment of thumb CMC arthritis.

💡Eden Littler Classification System

The Eden Littler Classification System is a radiographic evaluation method used to classify the severity of osteoarthritis in the thumb's CMC joint. The video mentions this system in the context of a comparative study that aimed to determine the best diagnostic tests for thumb CMC osteoarthritis.

💡Clinical Diagnosis

A clinical diagnosis is made based on the patient's medical history, symptoms, and physical examination findings, rather than solely on laboratory or imaging results. The video script points out that despite the importance of radiographic imaging, a clinical diagnosis is crucial, as changes seen on imaging do not always correlate with pain or disability.

💡Axial Pressure

Axial pressure in the context of the grind test refers to the force applied along the axis of the thumb metacarpal bone during the test. The video describes the application of axial pressure as part of the test procedure to elicit a response that can help in diagnosing CMC osteoarthritis.

💡Crepitus

Crepitus is a medical term used to describe a grating or crackling sensation felt by a patient or examiner during movement of a joint, often indicative of joint degeneration or injury. In the video, crepitus in the basal joint region of the thumb is mentioned as one of the sensations that can be felt during a positive grind test.

💡Physical Examination

Physical examination is a part of the clinical assessment where a healthcare provider checks the body for any signs of disease or abnormality. In the video, the physical examination is used in conjunction with the patient's history and qualitative assessment to diagnose and treat thumb CMC arthritis.

💡Physiotutors

Physiotutors is an educational platform that provides online courses and resources for physical therapy and related health professions. The video is presented by a representative of Physiotutors, who offers additional courses on the wrist and hand for further learning and professional development.

Highlights

Introduction to the grind test for carpal metacarpal osteoarthritis.

Thumb osteoarthritis affects a large proportion of the adult population.

Radiographic prevalence of thumb osteoarthritis reaches 90 percent in both men and women by the age of 80.

Thumb osteoarthritis can cause pain at the base of the thumb, progressive loss of thumb motion, weakness, and decreased coordination.

Qualitative assessment of history, physical examination, and radiographs are used to diagnose and treat thumb CMC arthritis.

A 2017 study by Saliental compared diagnostic tests for thumb CMC osteoarthritis.

The grind test in the study yielded a sensitivity of 64 percent and a specificity of 100 percent.

The grind test confirms the diagnosis of CMC osteoarthritis and may distinguish those who do not have it.

A negative grind test does not always imply negative radiographic evidence of thumb CMC osteoarthritis.

Thumb CMC osteoarthritis remains a clinical diagnosis, and radiographic changes do not necessarily need to cause disability or pain.

Moderate clinical value is given to the grind test.

Test procedure: Patient is in a sitting position with the hand placed on a stable surface.

The examiner grasps the patient's hand and wrist to stabilize it, keeping the wrist and metacarpals in neutral position.

The examiner grasps the thumb metacarpal, rotates it, and applies axial pressure on the trapezium.

The grind test is considered positive if the patient reports any pain or other sensations such as crepitus in the basal joint region of the thumb.

Conclusion: For more information on wrist and hand diagnoses and treatments, check out the Upper Limb Focus course on the wrist and hand.