Test for Distal Radial Ulnar Joint of the Wrist

Ballottment Test for Wrist DRUJ

Reliability and Validity Analysis of the Distal Radioulnar Joint Ballottement Test

Nagashima, M., Omokawa, S., Hasegawa, H., Nakanishi, Y., Kawamura, K., & Tanaka, Y. (2024). Reliability and validity analysis of the distal radioulnar joint ballottement test. The Journal of Hand Surgery, 49(1), 15–22. https://doi.org/10.1016/j.jhsa.2023.10.006

The Skinny: Distal radioulnar joint (DRUJ) wrist instability can be caused by triangular fibrocartilage complex (TFCC) injuries. This joint injury can be clinically determined with the ballottement provocative test. There are a handful of tests to determine DRUJ instability, but the ballottement test is an accurate manual test for DRUJ instability. This study looks at the validity of the ballottement test for TFCC injury using a 3-D electromagnetic tracking device. For this study, the examiner grasps the radius and the carpal bones while the other hand grasps the ulnar head and loads are applied in the volar and dorsal directions, which is different from the non-holding method in which the radius is grasped without grasping the carpal bones while the other hand grasps the ulnar head and loads are applied in the volar and dorsal directions.

Image from: Onishi, T., Omokawa, S., Iida, A., Nakanishi, Y., Kira, T., Moritomo, H., Ruxasagluwang, S., Kraisarin, J., Shimizu, T., & Tanaka, Y. (2016). Biomechanical study of distal Radioulnar Joint Ballottement Test. Journal of Orthopaedic Research, 35(5), 1123–1127. https://doi.org/10.1002/jor.23355 

In the Weeds: This study had 25 healthy participants (10 men and 15 women) and 8 participants with TFCC injuries (6 men and 2 women). Three orthopedic hand surgeons were utilized in the study to perform the ballottement test. A 3-D electromagnetic tracking device was used to measure the rotation angle of the forearm during the test.

Bringing it Home: This study was able to demonstrate that the ballottment wrist test using the holding technique was able to detect TFCC foveal tears with 80% accuracy 82% sensitivity, and 77% specificity. Due to the high diagnostic accuracy, the ballottment test was identified as an effective way to determine mild or moderate DRUJ instability.

Rating: 4/5

This study had several limitations:

1)    The sample size was small which isn’t the best representation 

2)    The study did not include those with DRUJ instability above grade 2

3)    There were no comparisons for age and sex

4)    The individual joint differences were not included

5)    The load applied to the ballottment test was not measured

6)    Joint laxity was not assessed

Despite the limitations, the study does prove that the ballottment test using the holding technique was able to detect TFCC foveal tears with 80% accuracy, allowing healthcare professionals to have an appropriate measure of TFCC foveal tears.

Photo: Onishi, T., Omokawa, S., Iida, A., Nakanishi, Y., Kira, T., Moritomo, H., Ruxasagluwang, S., Kraisarin, J., Shimizu, T., & Tanaka, Y. (2016). Biomechanical study of distal Radioulnar Joint Ballottement Test. Journal of Orthopaedic Research, 35(5), 1123–1127. https://doi.org/10.1002/jor.23355 

Leave a Comment






More To Read

Conservative Therapy for OA in the Fingers: A Literature Review

August 25, 2019

Beasley, J., Ward, L., Knipper-Fisher, K., Hughes, K., Lunsford, D., & Leiras, C. (2018). Conservative therapeutic interventions for osteoarthritic finger joints: A systematic review. Journal of Hand Therapy, 32. 153-164. The Skinny – The article reviews the evidence on the effectiveness of conservative treatment for those who experience osteoarthritis in fingers and in their finger…

Read More

Got Wounds? How to manage them as a Hand Therapist.

July 31, 2022

Wound care is messy. It can be intimidating and scary with so many variations of wounds (for example, white skin around wounds) and so many products out there, it is hard to know what to use, when to use it, and how to use it. If you go to a wound care conference, you’ll spend most of…

Read More

Our Favorite Mallet Finger Splints

February 16, 2023

By: Josh MacDonald Fabricating a custom splint for a mallet finger injury is challenging. Fingers are tiny and they have small tolerances for errors and adjustments with custom splints. Making a splint for a mallet finger injury is probably the hardest type of finger splint for a therapist to make.  Treatment recommendations vary, with some…

Read More
Envelope_1

Sign-up to Get Updates Straight to Your Inbox!

Sign up with us and we will send you regular blog posts on everything hand therapy, notices every time we upload new videos and tutorials, along with handout, protocols, and other useful information.