Watson Test for Scaphoid Instability

Описание: The scaphoid shift test or Watson Test came from a paper in 1986 by Dr. H Kirk Watson where he was describing rotatory subluxation of the scaphoid (Watson, H. K., Ryu, J. A. I. Y. O. U. N. G., & Akelman, E. (1986). Limited triscaphoid intercarpal arthrodesis for rotatory subluxation of the scaphoid. JBJS, 68(3), 345-349.). He discussed in the paper about classifying the type of subluxation because subluxation can lead to degenerative changes and therefore the classification can help with the treatment plan.

How to perform it from the original paper:
-Have the person sitting with their elbow supported on a table
-You are across from them and place the fingers of the same hand posterior to the radius and thumb on the tuberosity of the scaphoid
-Using your other hand, deviate the wrist ulnarly and then radially (the scaphoid is in line with the forearm with ulnar deviation and with radial deviation is is perpendicular to the forearm axis)
-Press on the scaphoid with your thumb which holds it from moving in the transverse position and move the wrist into ulnar and radial deviation
A positive is the scaphoid displacing dorsally along with pain

How to perform it:
-Have the person sitting with their elbow supported on a table
-You hold their wrist with your thumb on the palmar side of the scaphoid
-Using your other hand, put their hand into ulnar deviation and slight extension (lines up the scaphoid with the radius)
-Move their hand passively into radial deviation and slight flexion while applying pressure to scaphoid, this movement causes the scaphoid to tilt forward and press into your thumb
If there is a tear or laxity, the scaphoid will shift dorsally and when you take away the pressure from your thumb, it will reposition causing a painful “thunk”

There is a little bit of research on it. One study looked at the diagnostic significance of it (Schmauss, D., Pöhlmann, S., Weinzierl, A., Schmauss, V., Moog, P., Germann, G., ... & Megerle, K. (2022). Relevance of the scaphoid shift test for the investigation of scapholunate ligament injuries. Journal of Clinical Medicine, 11(21), 6322.). It was found that it may not be as good of a test for lower grade lesions or people with naturally laxity but pretty good with more serious lesions of the scapholunate ligament. Another paper used ultrasound during the test to determine a scapholunate ligament lesion and found it was reliable to do both in the diagnosis of lesions (Huber, N., Götschi, T., Schweizer, A., & Reissner, L. (2024). Catch the shift: Ultrasound diagnosis of scapholunate lesion during Watson test. Hand Surgery and Rehabilitation, 43(5), 101756.). It was stated in the first paper that this is a good test to have in the assessment of hands but use more extensive diagnostic tools if needed.

What do you think of this test? Do you use it? Do you like it? Let me know in the comments.

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