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A D V E R T I S E M E N T
A D V E R T I S E M E N T
When the physician is struggling to make a diagnosis as to whether the cause of thumb pain is originating in this joint, a Shepler "traction-release" test can be useful. It utilizes the knowledge that with traction longitudinally on the thumb ray, augmented by dorsal pressure on the base of the first metacarpal, this bone can move back closer to its original position. If pressure is maintained on the base of this metacarpal while traction is "released" combined with slight flexion of this bone, a grinding sensation (often with terrible pain) will be elicited as the base of the first metacarpal goes back into its dorsally-subluxed position.
A D V E R T I S E M E N T
As the joint destruction advances, erosion of the dorsal lip of the trapezial joint surface and the volar lip of the first metacarpal surface allows dorsal subluxation.
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A D V E R T I S E M E N T
Sometimes subluxation is so excessive, that frank dislocation can occur dorsally, although complete dislocation is rare.
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This page was last modified on 4/1/1999.
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