Derby Relocation Test

The Derby Relocation Test is a specialized clinical examination designed to assess the integrity of the lunotriquetral interval and evaluate for peritriquetral and triquetrolunate injuries. This test is particularly valuable in diagnosing instability patterns involving the triquetrum and lunate bones of the wrist, which are part of the proximal carpal row.

The test is specifically indicated when patients present with ulnar-sided wrist pain, particularly when there is suspicion of carpal instability involving the lunotriquetral joint. It serves as a diagnostic tool to differentiate between various causes of ulnar wrist pain and to identify patients who may benefit from further imaging studies or surgical intervention.

See Also: Triangular Fibrocartilage Complex Injury & Treatment

How to perform the Derby Relocation Test?

The Derby Relocation Test consists of an initial screening question followed by three sequential manual tests. The examination begins with the clinician asking the patient: “Does the wrist feel unstable or loose?” This subjective assessment establishes the baseline for the subsequent physical tests.

Test One: Position the patient seated with their arm resting on an examination table, elbow flexed to 90 degrees, and the wrist pronated, extended, and radially deviated. Place your thumb on the anterior (volar) aspect of the patient’s pisiform bone and apply a posteriorly directed force while simultaneously bringing the patient’s wrist into a neutral position. Maintain this position and assess the patient’s subjective response regarding wrist stability and grip strength.

Test Two: Move the patient’s wrist until they report the return of subjective instability. Position the wrist in pronation, radial deviation, and neutral flexion. Apply a posterior-to-anterior directed force to the dorsum of the patient’s triquetrum while simultaneously moving the wrist into ulnar deviation. Observe for pain response during this maneuver.

Test Three: Again, position the wrist until subjective instability returns, maintaining pronation, radial deviation, and neutral flexion. Place your thumb on the anterior aspect of the patient’s pisiform and apply a posteriorly directed force while ulnarly deviating the patient’s wrist. Compare the pain response to that experienced during Test Two.

What is a positive Derby Relocation Test?

The Derby Relocation Test is considered positive when the patient responds “yes” to the initial question about wrist instability AND demonstrates positive findings on the three sequential tests. The specific positive findings for each component are:

Test One: A positive response is characterized by resolution of the patient’s subjective feeling of wrist instability and improvement in grip strength that can be maintained for a longer duration when the repositioning force is applied to the pisiform.

Test Two: The test is positive when the patient experiences pain with the wrist positioned in ulnar deviation while the posterior-to-anterior force is applied to the dorsal triquetrum.

Test Three: A positive finding occurs when the patient experiences less pain during ulnar deviation compared to the pain experienced in Test Two, when the posteriorly directed force is applied to the pisiform.

The combination of all positive findings suggests lunotriquetral instability, with the pisiform acting as a stabilizing structure when properly positioned, and pain generation when the triquetrum is stressed without adequate support.

See Also: Wrist Pain Causes

Reliability and Validity

While the Derby Relocation Test represents an innovative approach to assessing lunotriquetral instability, comprehensive studies establishing its reliability and validity parameters are limited in the current literature.

However, clinicians should interpret results in conjunction with other clinical findings, patient history, and appropriate imaging studies. Inter-examiner and intra-examiner reliability studies would strengthen the evidence base for the Derby Relocation Test. Additionally, correlation with arthroscopic findings or advanced imaging techniques could further validate the test’s diagnostic accuracy.

References & More Reading

1. Orthopedic Physical Assessment by David J. Magee, 7th Edition.
2. Porretto-Loehrke A, Schuh C, Szekeres M. Clinicalmanual assessment of the wrist. J Hand Ther.2016;29(2):123–135. PubMed
3. Rhee PC, Sauve PS, Lindau T, Shin AY. Examination of the wrist: ulnar-sided wrist pain due to ligamentous injury. J Hand Surg Am. 2014;39(9):1859–1862. PubMed
4. Christodoulou Bainbridge LC. Clinical diagnosis of triquetrolunate ligament injuries. J Hand Surg Br. 1999;24(5):598–600. PubMed