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Scapho-Trapezial-Trapezoid (STT) Tenderness

Test, Exam and Sign Description

Historical Overview

  • Scaphotrapeziotrapezoid (STT) tenderness is indicative of STT arthritis. It may also indicate injury to the scaphotrapezial-trapezoidal ligament structures.
  • In 1978, Crosby et al1 reported that the commonly observed pantrapezial arthrosis, although often focused at the trapezium-metacarpal joint, could also involve the STT joint.

 

Description

  • Tenderness of the STT joint suggests that pain and weakness at the base of the thumb are due to STT arthritis.

 

Pathophysiology

  • The STT joint is a common site for osteoarthritis.2 It is possible that STT arthrosis is secondary to injury of the STT ligamentous structures.3

 

Instructions

1. Take patient history; there is an increased likelihood of STT arthritis with age >60 years

2. Palpate STT joint from volar, radial, and dorsal aspects

Presentation Photos and Related Diagrams
  • Palpating STT joint via the anatomic snuff box. Note you can not differentiate scaphoid tenderness from STT tenderness.
    Palpating STT joint via the anatomic snuff box. Note you can not differentiate scaphoid tenderness from STT tenderness.
Definition of Positive Result
  • A positive result occurs when there is point tenderness and increased pain with pressure.
Definition of Negative Result
  • A negative result occurs when pressure does not elicit tenderness.
Comments and Pearls
  • The progression of arthritic changes in the STT joint can be assessed with plain x-rays.2
  • It may be impossible to tell on physical exam alone whether tenderness in the anatomic snuff box is secondary to a scaphoid fracture, scaphoid nonunion or STT arthritis. The distinction will usally equire an X-ray.
Diagnoses Associated with Tests, Exams and Signs
SCAPHOID FRACTURE
References

1. Crosby EB, Linscheid RL, Dobyns JH. Scaphotrapezial trapezoidal arthrosis. J Hand Surg Am 1978;3(3):223-234. PMID: 659818

2. Drewniany JJ, Palmer AK, Flatt AE. The scaphotrapezial ligament complex: An anatomic and biomechanical study. J Hand Surg Am 1985;10(4):492-498. PMID: 4020059

3. Scordino LE, Bernstein J, Nakashian M, et al. Radiographic prevalence of scaphotrapeziotrapezoid osteoarthrosis. J Hand Surg Am 2014;39(9):1677-1682. PMID: 25037508