Maximal and Explosive Muscle Strength During Hip Adduction Squeeze and Hip Abduction Press Test Using A Handheld Dynamometer: An Intra- and Inter-tester Reliability Study.

Background: Hip adduction and abduction muscle function plays an important role for risk of groin pain in athletes. Maximal isometric strength can be obtained clinically using a handheld dynamometer. However, in very strong athletes this is challenging, as external fixation of the dynamometer is needed for reliable measures. An alternative to unilateral testing, is the long-lever hip adduction squeeze test and a novel bilateral hip abduction press test. While promising intra-tester reliability has been found for maximal strength during the long-lever hip adduction squeeze test, inter-tester reliability may be more challenging during both maximal and explosive strength measurements. Hypothesis/purpose: The aim of the present study was to assess intra- and inter-tester reliability of maximal, and explosive strength during the long lever hip adduction squeeze test and the long lever hip abduction press test in healthy adults using a hand-held dynamometer. Study design: Intra- and interrater reliability study. Methods: Forty-nine healthy subjects were included for intra- (n=20) and inter-tester reliability (n=29). Subjects performed the hip adduction long lever squeeze test and the bilateral hip abduction press test in a randomized order. Maximal isometric strength and early (0-100 ms) and late (0-200 ms) phase rate of force development (explosive muscle strength) was obtained using a hand-held dynamometer. Relative reliability for all tests was assessed using ICC2,1 two-way mixed model with absolute agreement, thereby taking bias between testers into account. Results: Maximal isometric strength showed good intra- and inter-tester reliability for adduction (ICC: 0.93-0.97) and abduction (ICC: 0.88-0.92). For 0-200 ms rate of force development, both the squeeze and press test showed good intra-tester reliability (ICC: 0.85-0.87), whereas inter-tester reliability was good for hip adduction squeeze (ICC: 0.75) and moderate for hip abduction press (ICC: 0.71). For 0-100 ms rate of force development, the hip abduction press test showed good intra-tester reliability (ICC: 0.78). Remaining tests for intra- and inter-tester reliability showed moderate reliability (ICC: 0.50-0.71). Conclusion: Assessment of maximal isometric strength in hip adduction squeeze and abduction press test showed good intra- and inter-tester reliability, whereas only 0-200 ms rate of force development demonstrated good intra-tester reliability of both tests. Therefore, rate of force development should preferably be conducted by the same tester, while the long lever squeeze and press test can reliably be used within- and between testers to measure maximal isometric strength. Level of Evidence: 3©The Author(s).

Funcionalidad y fuerza de aductores en jugadores de hockey sobrepatines de alto nivel / Adductor functionality and strength in high-level rink hockey players

Objetivo: Evaluar la fuerza de los músculos aductores y la funcionalidad en jugadores de hockey sobre patines de alto nively su relación con sufrir dolor inguinal (DI) en la temporada anterior. Material y método: Se realizó un estudio transversal donde se registraron los valores de fuerza mediante el Squeeze Test de5 segundos (5SST), y la funcionalidad de la cadera e ingle mediante el cuestionario Hip and Groin Outcome Score (HAGOS) enuna población de 11 jugadores de hockey sobre patines de alto nivel. Resultados: La prevalencia total de DI fue de 81,8% (en la anterior temporada el 54% sufrió DI), de los cuales un 18,2% llegóa detener la práctica deportiva. La fuerza media para el 5SST es de 254,68N (3,25Nm/kg) y la funcionalidad alcanzó los 90/100puntos en el cuestionario HAGOS para toda la muestra. La fuerza muscular fue similar entre jugadores que habían sufridoDI con pérdida de tiempo durante la última temporada y jugadores sanos en (p =0,261-0,948; g: 0,04-0,85). Se encontrarondiferencias significativas en las siguientes subescalas del cuestionario HAGOS: Dolor, actividades deportivas y recreacionales,y calidad de vida entre ambos grupos (p =0,005-0,042; g: 0,34-2,65; r: 0,3-0,61). Conclusión: Más de la mitad de los jugadores sufrieron DI, de los cuales un tercio llegó a detener su actividad. La funcionalidadmedida a través del HAGOS se erige como el principal indicador que mostró diferencias entre grupos. Los servicios médicosde jugadores jóvenes de hockey sobre patines deberían usar este cuestionario para poder detectar precozmente la aparicióny evitar la progresión de esta lesión.(AU)

Objective: To evaluate adductor strength and groin function in high level rink hockey players and its relationship with groinpain in the previous season. Material and method: A cross-sectional study was performed where hip/groin strength and function was assessed via 5seconds Squeeze Test and Hip and Groin Ouctome Score in 11 high level rink hockey players. Results: Overall prevalence for groin pain was 81.8% (54% of the participants suffered groin pain during the previous season),and 18.2% suffered time-loss groin pain. Mean strength in the 5SST was 254.68N (3.25Nm/Kg) and HAGOS questionnairereached 90/100 points in the whole sample. Similar adductor strength values were observed between healthy athletes andpreviously injured who suffered time-loss groin pain (P=0.261-0.948; g: 0.04-0.85). Statistically significant differences werefound for the following HAGOS subscales: Pain, function, sports and recreational activities, and quality of life between groups(P=0.005-0.042; g: 0.34-2.65; r: 0.3-0.61). Conclusion: More than a half of the participants suffered groin pain, of which one third suffered time-loss groin pain. Functionassessed via HAGOS seems to be the main proxy that discriminates between groups. Medical staff should implement thisquestionnaire to detect and avoid the progression of this injury.(AU)

Association of the Clinical and Radiographic Findings at Onset With Future Joint Destruction in Patients With Rheumatoid Arthritis.

OBJECTIVES: Since inflammation can cause joint destruction in patients with rheumatoid arthritis (RA), it is assumed that joints that are symptomatic at onset are at higher risk of joint destruction; however, this theory remains controversial. This study aimed to investigate whether the progression of joint destruction in hands and feet could be predicted from the clinical and radiographic findings at onset. METHODS: This study included 75 patients who visited our hospital within one year after the onset of RA with at least 12 months of follow-up. We examined the positive predictive value (PPV) and the sensitivity of the clinical findings (swelling, tenderness, and squeeze test) and joint destruction at onset for the progression of joint destruction. RESULTS: Sixty joints (45 metacarpophalangeal and proximal interphalangeal joints, 15 metatarsophalangeal joints) exhibited progressive structural destruction during the study course. Both the PPV and the sensitivity of the clinical findings for the progression of joint destruction were low; however, only the sensitivity of the squeeze test for the feet was high. The PPV of joint destruction at onset was higher than the clinical findings, and the sensitivity of joint destruction at onset was as high as the squeeze test for the feet.  Conclusions: Regular follow-up with imaging is necessary regardless of symptoms and joint destruction at the onset. Adding the squeeze test for feet to routine clinical practice may help predict the risk of joint destruction for the feet.

Physical Examination of Ankle Sprain and Ankle Instability: Can We Really Divide It into Low and High Ankle Sprains?

Lateral ankle ligament sprains and syndesmotic injuries are two different entities. However, they may be combined under the same spectrum depending on the arch of violence during the injury. Currently, the clinical examination has a limited value in the differential diagnosis between an acute anterior talofibular ligament rupture and a syndesmotic high ankle sprain. However, its use is indispensable for raising a high index of suspicion for detecting these injuries. Based on the mechanism of injury, clinical examination plays an essential role in guiding further imaging and early diagnosis of low/high ankle instability.

Reliability and validity of common hip adduction strength measures: The ForceFrame strength testing system versus the sphygmomanometer.

OBJECTIVES: The criterion validity of the sphygmomanometer was evaluated, relative to the Force Frame strength testing system. Test-retest reliability was assessed for both hip adduction and abduction strength. DESIGN: Test-retest reliability study and criterion validity study. PARTICIPANTS: 50 asymptomatic, field-sport athletes. MAIN OUTCOME MEASURES: Maximal isometric hip adduction and abduction strength were measured. Interclass correlation coefficient(ICC2,1) with confidence intervals were calculated to evaluate reliability of peak strength values. A Pearson product-moment correlation coefficient(r) was calculated to examine criterion validity of the sphygmomanometer as a measure of force when compared to the ForceFrame. RESULTS: Intra-rater reliability for bilateral adduction testing using both ForceFrame and sphygmomanometer values revealed good-excellent reliability for both the 0° (ICC2.1 = 0.87-0.90) and 45° (ICC2.1 = 0.81-0.91) positions. ForceFrame values revealed good-excellent reliability for 0° abduction position and 45° abduction position. A good-moderate relationship (Pearson's r = 0.63) for 0° adduction position, and poor relationship (Pearson's r = 0.40) for 45° adduction position, were found between adduction squeeze values on ForceFrame and sphygmomanometer. CONCLUSION: Excellent reliability in hip adduction squeeze strength testing for both modes. However, there exists a 'good to moderate'-'fair' relationship between the Force Frame and sphygmomanometer.

Unnecessary Cervical Discectomy - A simple test to differentiate between Cervical and Shoulder Pathology: A Case Report.

Background: Diagnostic dilemma exists in differentiating between neck and shoulder pathology, as both can give a rise to shoulder and arm symptoms. In addition, the hypersensitivity of magnetic resonance imaging (MRI) scans may wrongly highlight non-clinically significant changes as potential targets for surgical intervention. The arm- squeeze test is a recognised recognized method used to help differentiate pathology arising from the shoulder or the neck. Performing this test preoperatively may prevent needless surgical intervention when diagnostic difficulties exist, even when MRI scans are not helpful. Case Presentation: We report the case of a 41-year-old male who initially presented with numbness and pins and needles in both arms. Following clinical review and an MRI scan of the cervical spine, the patient underwent an Anterior Cervical Discectomy and Fusion. Unfortunately, there was no relief of symptoms following surgery. A post- operative clinical review identified the shoulder as a potential cause of the symptoms. Conclusion: The arm- squeeze test is not popular and is not routinely used in shoulder and cervical spine examinations. However, it is recommended by National Institute for health and care excellence to help differentiate between neck and shoulder pathology, and, hence, dissemination of this information is vital.

Validity and Reliability of The Smart Groin Trainer for Measuring Hip Adduction Strength.

We analyzed the Smart Groin Trainer device's validity and reliability to measure the isometric hip adduction strength during the adductor squeeze strength test. Fifteen professional soccer players (25.33±4.06 years) and fifteen university students (21.60±1.76 years) participated in this study. All participants performed the squeeze strength test using two portable dynamometers: Smart Groin Trainer and Globus Ergometer. Three maximal isometric hip adduction contractions lasting 5s, interspersed by 3min rest intervals, were performed. Reliability was analyzed with intraclass correlation coefficients, standard error of measurements, and minimal detectable change. The absolute percent error and inter-device accuracy were also analyzed. Correlation analysis assessed the inter-device concurrent validity. The results found no significant differences (p>0.05) between devices in the squeeze strength test values in soccer players and university students. Inter-device comparisons revealed excellent levels of reliability and accuracy in soccer players. Concurrent validity measures revealed strong inter-device relationships in soccer players (r=0.89) and very strong relationships in university students (r=0.99). Intra-device analysis using the Smart Groin Trainer showed excellent relative and absolute reliability in tested soccer players. Our data demonstrated excellent levels of agreement between both dynamometers during the squeeze strength test, suggesting the Smart Groin Trainer as a valid, reliable, and accurate device to measure isometric hip adduction strength.

Hip adduction strength and provoked groin pain: A comparison of long-lever squeeze testing using the ForceFrame and the Copenhagen 5-Second-Squeeze test.

OBJECTIVES: To compare long-lever squeeze testing using the ForceFrame and the Copenhagen 5-Second-Squeeze test (5SST) for assessment of hip adduction strength and provoked groin pain in elite male soccer players. DESIGN: Cross-sectional study. SETTING: Pre-season testing at facilities of a Danish professional 1st tier soccer club and academy. PARTICIPANTS: Elite male soccer players (n = 83, mean age; 16 ± 2.7 years) from U13, U14, U15, U17, U19 and senior teams cleared for full training and match participation. MAIN OUTCOME MEASURES: Maximum isometric hip adduction strength (Nm/kg) and provoked groin pain (NRS 0-10). RESULTS: Hip adduction strength was 16% lower in the ForceFrame. A Bland-Altman plot showed a systematic bias (-0.47 Nm/kg, 95% CI [-0.57; -0.38]) and lack of agreement (95% limits of agreement: -1.31; 0.39 Nm/kg). In the ForceFrame, provoked groin pain was less intense (median NRS 0 [IQR: 0-1] vs. 5SST: 1 [IQR: 0-3], p < 0.001) and reported by fewer players (NRS >0) (27% [n = 22] vs. 5SST: 61.4% [n = 51], p < 0.001). CONCLUSIONS: The ForceFrame and the 5SST lack agreement and are not interchangeable methods. This may have implications when selecting a method for screening and detecting early groin problems in male soccer players.

Which inflamed tissues explain a positive metatarsophalangeal squeeze test? A large imaging study to clarify a common diagnostic procedure.

OBJECTIVES: The squeeze test of MTP joints is frequently used because it is easy and cheap. It is traditionally perceived as a test for synovitis. Besides classic intra-articular synovitis, also tenosynovitis and intermetatarsal bursitis (IMB) represent synovial inflammation, albeit juxta-articularly located. Both are frequently present in RA and occasionally in other arthritides. Therefore we hypothesized that tenosynovitis and IMB contribute to a positive MTP squeeze test. METHODS: A cross-sectional study design was used. A total of 192 early arthritis patients and 693 clinically suspect arthralgia patients underwent the MTP squeeze test and forefoot MRI at first presentation. MRI measurements in age-matched healthy controls were used to define positivity for synovitis, tenosynovitis and IMB. Logistic regression was used. RESULTS: In early arthritis patients, synovitis [odds ratio (OR) 4.8 (95% CI 2.5, 9.5)], tenosynovitis [2.4 (1.2, 4.7)] and IMB [1.7 (1.2, 2.6)] associated with MTP squeeze test positivity. Synovitis [OR 3.2 (95% CI 1.4, 7.2)] and IMB [3.9 (1.7, 8.8)] remained associated in multivariable analyses. Of patients with a positive MTP squeeze test, 79% had synovitis or IMB: 12% synovitis, 15% IMB and 52% both synovitis and IMB. In clinically suspect arthralgia patients, subclinical synovitis [OR 3.0 (95% CI 2.0, 4.7)], tenosynovitis [2.7 (1.6, 4.6)] and IMB [1.7 (1.2, 2.6)] associated with MTP squeeze test positivity, with the strongest association for synovitis in multivariable analysis. Of positive MTP squeeze tests, 39% had synovitis or IMB (10% synovitis, 15% IMB and 13% both synovitis and IMB). CONCLUSION: Besides synovitis, IMB contributes to pain upon compression in early arthritis, presumably due to its location between MTP joints. This is the first evidence showing that MTP squeeze test positivity is not only explained by intra- but also juxta-articular inflammation.

Intermetatarsal bursitis as first disease manifestation in different rheumatological disorders and related MR-imaging findings.

Metatarsalgia defined as pain at the plantar aspect of the forefoot. Intermetatarsal bursitis is considered one potential soft-tissue cause of metatarsalgia that is presumably under-estimated, under-investigated, and, consequently, often misdiagnosed. To assess the role of MRI in the elucidation of the cause of metatarsalgia in patients with different autoimmune disorders presenting primarily with this symptom and to present the accompanying clinical and radiological findings of intermetatarsal bursitis. Retrospective evaluation of the medical records of patients with different rheumatological conditions claiming primarily of pedal pains suggests metatarsalgia and who underwent, therefore, all magnetic resonance imaging between March 2010 and April 2018. Of them, six patients fulfilled these criteria and were diagnosed subsequently with intermetatarsal bursitis. Several underlying autoimmune conditions were diagnosed. All patients were clinically assessed by the squeeze test and radiologically investigated with MRI; three patients underwent additional sonography. All patients presented intermetatarsal bursitis as first disease manifestation. The number of involved bursae ranged from one to three on one side. The main MR findings were distension of the intermetatarsal bursa with increased signal intensity on T2-weighted and post-contrast fat saturation T1-weighted images. Most frequent locations were the second and third intermetatarsal spaces. The size of the intermetatarsal bursitis and its plantar extension were correlated in all patients. Intermetatarsal bursitis can potentially be the first manifestation of different rheumatological diseases. Awareness of this potential association as well as cognizance of its imaging findings can help for making a more accurate and prompt earlier diagnosis of the underlying disease changing also the therapeutic approach.

Value of physical tests in diagnosing cervical radiculopathy: a systematic review.

BACKGROUND CONTEXT: In clinical practice, the diagnosis of cervical radiculopathy is based on information from the patient's history, physical examination, and diagnostic imaging. Various physical tests may be performed, but their diagnostic accuracy is unknown. PURPOSE: This study aimed to summarize and update the evidence on diagnostic performance of tests carried out during a physical examination for the diagnosis of cervical radiculopathy. STUDY DESIGN: A review of the accuracy of diagnostic tests was carried out. STUDY SAMPLE: The study sample comprised diagnostic studies comparing results of tests performed during a physical examination in diagnosing cervical radiculopathy with a reference standard of imaging or surgical findings. OUTCOME MEASURES: Sensitivity, specificity, likelihood ratios are presented, together with pooled results for sensitivity and specificity. METHODS: A literature search up to March 2016 was performed in CENTRAL, PubMed (MEDLINE), Embase, CINAHL, Web of Science, and Google Scholar. The methodological quality of studies was assessed using the QUADAS-2. RESULTS: Five diagnostic accuracy studies were identified. Only Spurling's test was evaluated in more than one study, showing high specificity ranging from 0.89 to 1.00 (95% confidence interval [CI]: 0.59-1.00); sensitivity varied from 0.38 to 0.97 (95% CI: 0.21-0.99). No studies were found that assessed the diagnostic accuracy of widely used neurological tests such as key muscle strength, tendon reflexes, and sensory impairments. CONCLUSIONS: There is limited evidence for accuracy of physical examination tests for the diagnosis of cervical radiculopathy. When consistent with patient history, clinicians may use a combination of Spurling's, axial traction, and an Arm Squeeze test to increase the likelihood of a cervical radiculopathy, whereas a combined results of four negative neurodynamics tests and an Arm Squeeze test could be used to rule out the disorder.

Comparison of trapezius squeeze test and jaw thrust as clinical indicators for laryngeal mask airway insertion in spontaneously breathing children.

BACKGROUND AND AIMS: It is not known whether trapezius squeeze test (TPZ) is a better clinical test than jaw thrust (JT) to assess laryngeal mask airway (LMA) insertion conditions in children under sevoflurane anesthesia. MATERIAL AND METHODS: After the Institutional Ethics Committee approval and written informed parental consent, 124 American Society of Anesthesiologists I and II children of 2-8 years of age undergoing minor surgical procedures were randomized into TPZ and JT groups. The children were induced with 8% sevoflurane in oxygen at a fresh gas flow of 4 L/min. TPZ or JT was performed after 1 min of start of sevoflurane and then every 20 s till the test was negative, when end-tidal (ET) sevoflurane concentration was noted. Classic LMA of requisite size was inserted by a blinded anesthetist and conditions at the insertion of LMA, insertion time, and the number of attempts of LMA insertion were recorded. RESULTS: The mean LMA insertion time was significantly longer (P < 0.001) for TPZ (145 ± 28.7 sec) compared to JT group (111.8 ± 31.0 sec). ET sevoflurane concentration at the time of LMA insertion was comparable in the two groups. LMA insertion conditions were similar in the two groups. There was no difference between the two groups regarding total number of attempts of LMA insertion. Heart rate (HR) decreased in both groups after LMA insertion (P < 0.001) but TPZ group had significantly lower HR compared with the JT group up to 5 min after LMA insertion (P = 0.03). CONCLUSION: Both JT and TPZ are equivalent clinical indicators in predicting the optimal conditions of LMA insertion in spontaneously breathing children; however, it takes a longer time to achieve a negative TPZ squeeze test.

Do rheumatologists know how to squeeze? Evaluations of Gaenslen´s maneuver.

The Gaenslen´s compression maneuver is the application of pressure on the metacarpophalangeal joints in order to evoke pain on a patient who has active synovitis. The results from the use of the maneuver are seen as controversial due to the lack of information describing the technique required for this procedure. The present study will aim to clarify uncertainty in regard to the form, pressure, and time required to apply the maneuver by rheumatologist. Rheumatologist were observed and monitored while performing the Gaenslen compression maneuver on a prosthetic, biomedical device. The device was shaped to mimic a human hand and equipped with a sensor to monitor the force and time of which the pressure was applied. One hundred and eight (62 %) participants gave a valid recording. From these, 121 (87.7 %) were made by certified rheumatologists. The most predominant method (104 physicians/75.4 %) of applying the maneuver was by using the right hand with superior approach. The median strength calculated in grams resulted in 299 gr (IQR 145) (range 150-741 gr). The median time expressed in milliseconds was of 956.6 ms (IQR 824.6) . This is the first study to assess a clinical maneuver in a qualitative and quantitative manner. The results from this study, more specifically the low number of usable recordings, and the wide range of force exerted in the squeeze test may explain the differences in sensitivity and specificity in clinical studies.

Normative adductor squeeze tests scores in rugby.

BACKGROUND: Groin pain is a common problem. Adductor squeeze tests are used to diagnose, monitor and prophylactically determine the risk of developing groin pain. This study defines normative adductor squeeze scores in professional rugby that will facilitate strength monitoring during screening. METHODS: Using a sphygnamometer, squeeze scores were collected, at one professional rugby club as part of the pre-season screening for two seasons. Scores were collected in four positions. For all positions mean strength and 95% confidence intervals were calculated. RESULTS: Data were collected for 81 athletes. Mean strength for adduction at 60° was 220.1 (212.2-228.1); 0° 211.1 (201.7-220.5); 90°90° 198.8 (190.0-207.7); 90°90° supported 224.9 (214.9-234.9). Backs had lower squeeze scores than forwards for 0°, 90°:90° and 90°:90° supported (p > 0.05 for all four tests); older players had lower scores, as did shorter and lighter players (p > 0.05 except for height with test 60° p = 0.048 and test 90°:90° supported p = 0.035). CONCLUSION: This study establishes references ranges for adductor squeeze tests for normative pre-season data in non-injured rugby players. This information will enable evaluation and inform return to play judgements following adductor related injury.

The lambda sign: a new radiographic indicator of latent syndesmosis instability.

BACKGROUND: Latent syndesmotic instability is a common cause of chronic ankle pain. The diagnosis is not readily apparent on static imaging as the fibula remains reduced. The hypothesis of this study was that a previously undescribed novel finding on coronal MRI (lambda sign) is an independent indicator of latent syndesmosis instability. We also report on the utility of classic radiographic and physical exam findings. METHODS: A total of 23 patients with latent syndesmotic instability diagnosed via arthroscopy (group I) were compared to a cohort of 40 patients who were found to have a stable syndesmosis during arthroscopy for unrelated conditions (group II). A retrospective chart review was performed evaluating their clinical history, preoperative physical examination, and radiologic findings. The lambda sign is a high intensity signal seen on coronal MR imaging that resembles the Greek letter lambda. RESULTS: All of the physical exam findings tested were statistically significant. Pain at the syndesmosis had the highest sensitivity (83%), while pain reproduced with the proximal squeeze test resulted in the highest specificity (89%). The external rotation stress test had the highest positive predictive value (75%). Of the radiographic examinations performed, only the lambda sign was found to have statistical significance with a sensitivity of 75% and a specificity of 63%. The presence of a lambda sign on the MRI of patients with physical exam findings suggestive of syndesmotic pain was highly sensitive (75%) and specific (85%). CONCLUSION: The lambda sign noted on the coronal MRI was both sensitive and specific for injuries involving greater than 2 mm of diastasis on arthroscopic stress examination of the syndesmosis. While neither the lambda sign nor any other finding on physical or radiographic examination represented an independent predictor of syndesmotic instability, the presence of a lambda sign in concert with positive physical exam findings might help health care providers determine which patients might benefit from operative intervention or referral. LEVEL OF EVIDENCE: Level III, case control study.

Comparación entre test de squeeze positivo y hallazgos ecográficos en pacientes con artritis reumatoidea / Comparison between positive squeeze test and ultrasound findings in patients

Objetivos: Evaluar si existe una asociación entre el test de Squeeze (TS) positivo y el hallazgo ecográfico de sinovitis en las articulaciones metacarpofalángicas (MCF) y metatarsofálangicas (MTF) de pacientescon diagnóstico de artritis reumatoidea (AR). Resultados: Se evaluaron 35 pacientes con diagnóstico de AR, 85% mujeres, con una mediana de edad de 57 años (RIC 50,5-64), y una mediana de tiempo de evolución de 10 años (RIC 4-15). La sensibilidad (S) y especificidad (E) del test de Squeeze para detectar al menos una MCF dolorosa fue de 81% y 90%, respectivamente. Para detectarinflamación en MCF, el test tuvo una S de 62% y una E de 78%. En pies, el test presentó un menor desempeño, con S y E menores. En la evaluación ecográfica de pacientes con TS positivo se observó una mayor frecuencia de hipertrofia sinovial, distensión articular y señal Doppler en manos, e hipertrofia sinovial y distensión articular en pies. Sin embargo, ninguno de estos hallazgos alcanzó significancia estadística. El test de Squeeze en manos tuvo una S de 50% y E de 84% para detectar señal Doppler. Conclusiones: El test de Squeeze demostró ser útil para detectar articulaciones dolorosas, especialmente en las manos. En este estudio no se encontró una asociación significativa con hallazgos ecográficos. La sensibilidad del test en manos y pies para detectar efecto Doppler no fue buena, pero la especificidad fue aceptable.

Objectives: To assess whether a association exists between thepositive Squeeze test (ST) and ultrasound finding of synovitis in themetacarpophalangeal (MCP) and metatarsophalangeal (MTP) of patientswith rheumatoid arthritis (RA). Results: We evaluated 35 patients with RA, 85% were female, with a median age of 57 years (IQR 50.5-64) and a median disease duration of 10 years (IQR 4-15). The sensitivity (S) and specificity (Sp) for the Squeeze test in detecting at least one painful MCP was 81% and 90%, respectively. To detect inflammation in MCP joints, the testhad a sensitivity of 62% and a specificity of 78%. The test showeda worse performance in feet, with less S and Sp. In the ultrasonographicevaluation of patients with positive TS, we found a higher frequency of synovial hypertrophy, distension and Doppler signal in hands, and synovial hypertrophy and distension in feet. However, none of these findings reached statistical significance. Squeeze test in hands had a S of 50% and Sp of 84% to detect Doppler. Conclusions: The Squeeze test proved to be useful in detecting painful joints, especially in hands. This study found no significantassociation with ultrasound findings. The sensitivity of the test to detect Doppler was not good, but the specificity was acceptable.