Clinical Rheumatology

, Volume 31, Issue 9, pp 1309–1317 | Cite as

Sensitivity of standardised musculoskeletal examination of the hand and wrist joints in detecting arthritis in comparison to ultrasound findings in patients attending rheumatology clinics

  • Hani AlmoallimEmail author
  • Suzan Attar
  • Nahid Jannoudi
  • Nizar Al-Nakshabandi
  • Basem Eldeek
  • Omar Fathaddien
  • Hussien Halabi
Original Article


The aim of this study is to standardise the muscuoloskeletal (MSK) examination of the hand and wrist joints and to determine the sensitivity of this standard exam to diagnose arthritis in comparison to ultrasound (US) findings. A standardised approach to MSK examination of the hand and wrist joints was formulated. It consists of inspection, followed by screening exam based on active range of motion testing, and then using specific techniques to detect clinical swelling and tenderness. The scissor and squeeze techniques for metacarpophalangeal (MCP) joints, 4-finger technique for the proximal interphalangeal (PIP) joints and 2-thumb technique for the wrist joints. Patients aged 18–75 years with symptoms suggestive of inflammatory arthritis for more than 3 months were included in the study from two centres. Two rheumatologists conducted MSK examination, while a grayscale with power Doppler US was performed by two ultrasonographers recording signs of arthritis (effusion, proliferation and hyperaemia) on the same day of visit. Statistical analysis was carried out to compare MSK examination findings in detecting swelling and tenderness to US examination findings. A total of 2,112 joints were assessed both clinically and with US. Using a standard MSK examination by a rheumatologist to detect clinical swelling showed the following sensitivities as compared to US findings: 4-finger technique of 69 % in third PIP, the scissor technique of 74 % in second MCP and 70 % in third MCP, and the 2-thumb technique of 80 % at the wrist joint. The MCP squeeze technique showed sensitivity of 66 % for tenderness. A standard MSK examination with its described techniques is a sensitive tool if used appropriately to diagnose clinical arthritis as compared to US.


Accuracy Arthritis Diagnosis MSK examination Musculoskeletal Standardised Ultrasound 



The authors express their great thanks to Alzaidi scientific chair of research in rheumatic diseases at Umm Al-Qura University that supported and funded the study, and to Abbott pharmaceuticals that provided US machines and trained ultrasonographer physicians. The authors also thank Dr. Shereen Aljohari for her extensive efforts in data collection.




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Copyright information

© Clinical Rheumatology 2012

Authors and Affiliations

  • Hani Almoallim
    • 1
    • 2
    Email author
  • Suzan Attar
    • 3
  • Nahid Jannoudi
    • 4
  • Nizar Al-Nakshabandi
    • 5
  • Basem Eldeek
    • 6
  • Omar Fathaddien
    • 3
  • Hussien Halabi
    • 2
  1. 1.Department of MedicineUmm Al-Qura UniversityMakkahSaudi Arabia
  2. 2.Department of MedicineKing Faisal specialist HospitalJeddahSaudi Arabia
  3. 3.Department of MedicineKing Abdulaziz UniversityJeddahSaudi Arabia
  4. 4.Department of MedicineDr. Soliman Fakeeh HospitalJeddahSaudi Arabia
  5. 5.Department of RadiologyKing Saud UniversityRiyadhSaudi Arabia
  6. 6.Departmentof Community MedicineKing Abdulaziz UniversityJeddahSaudi Arabia

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