RESUMO

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.

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RESUMO

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.

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