Background/Purpose: Gaenslen’s test positivity is characterized by tenderness upon
lateral compression (squeezing) of the metacarpophalangeal (MCP) or
metatarsophalangeal (MTP) joints. Joint ultrasonography (US) is a useful
clinical tool that has increasingly been applied in routine practice in
Rheumatology, given its sensitivity over clinical examination for detection of
inflammation. The aim of
this work was to
evaluate the agreement between Gaenslen’s test and MTP US findings.

Methods: Consecutive patients referred
to the Early Arthritis Clinic in the Rheumatology Unit, in whom arthritis was
identified and feet US performed, were included. The following parameters were assessed
at the first consultation: (1) spontaneous pain reported by the patient; (2)
squeeze test of the MTPs joints; (3) ultrasound MTP synovitis defined as
≥ grade 2 synovial hyperthrophy and/or ≥ grade 1 power-Doppler, identified by an experienced
sonographer. Chi-square and Cohen’s kappa
tests were used to analyse concordance between both
methods.

Results: One hundred patients
(200 feet) were included (64% women and a mean age of 53±16 years) with half of
the patients referring forefoot symptoms spontaneously. None of them presented
Morton’s neuroma in US, and significant hallux valgus was identified in 8 feet
(4%). The Gaenslen’s test was
positive in 45.0% cases. Among patients with negative Gaenslen’s
test, 83.6% were free of US changes. The agreement
proportion was lower when Gaenslen’s test was positive, with 44.4% having normal US. This
difference of proportions was statistically significant (Chi2=33.882;
p<0.001; Kappa=0.401), revealing a
sensitivity and specificity of 73.5%
and 69.7%, respectively.
A negative predictive value of 83.6% was obtained
for Gaenslen’s test.

Conclusion: In this study a
negative Gaenslen’s test of MTP corresponded to a normal US in 84% of the cases.
Thus, Gaenslen’s test has a high negative predictive value, and may be used as
a screening test to exclude MTP involvement in patients with Early Arthritis,
without the need for US examination. Positive Gaenslen’s
test is not regularly related
with US abnormalities and may, therefore, justify US examination. Further studies with larger samples are
warranted.