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

Abstract

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 299gr (IQR 145) (range 150-741gr). The median time expressed in milliseconds was of 956.6ms (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.