Diagnostic accuracy of history taking, physical examination, and auxiliary examination for thumb osteoarthritis: a systematic review

To conduct a systematic review to evaluate the diagnostic accuracy of history taking, physical examination, and auxiliary examination for thumb osteoarthritis (OA). MEDLINE ALL, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science Core Collection, and CINAHL were searched up to October 2023. Studies focused on patients with hand or thumb pain suspected of thumb OA, considering any diagnostic methods as the index test, with any diagnostic assessment of thumb OA as the reference standard were included. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were extracted. QUADAS and GRADE were applied to assess the evidence. Seven studies were included. History taking (two studies, 1096 participants) showed very low certainty of evidence;physical examination (five studies, 427 participants) revealed moderate certainty of evidence; auxiliary examinations (one study, 20 participants) indicated low certainty of evidence. History taking showed sensitivity of 47% to 100%, specificity of 40% to 63%, and accuracy of 40% to 80%. Physical examination demonstrated sensitivity of 2% to 100%, specificity of 75% to 100%, and accuracy of 47% to 98%. Auxiliary examination exhibited sensitivity of 72%, specificity of 86%, and accuracy of 76%. The adduction test, extension test, and metacarpal pressure-shear tests were reported to have accuracy above 90% based on two studies. Based on few studies, the diagnostic accuracy of history taking and physical examination for thumb OA varied across studies, while knowledge about auxiliary examination was limited. The adduction test, extension test, and metacarpal pressure-shear test are recommended for thumb OA diagnosis.