Ballottement Test for Lunotriquetral (LT) Ligament Tear

Historical Overview

• The ballottement test is derived from the French word ballottement, meaning “a tossing about.” In this test, carpal bones are moved to determine whether there is a lunotriquetral (LT) ligament tear. LT ligament tears are rare and often diagnosed in conjunction with other wrist pathology.

Description

• The ballottement test assesses LT ligament instability.  If the LT ligament is damaged, the triquetrum and lunate may become misaligned, which in turn, may cause pain with wrist movement.  

Pathophysiology

• LT ligament instability may arise from a LT ligament tear.  If the tear is severe and left untreated, osteoarthritis may ensue.

Instructions

1. On the patient’s affected hand, push up on the triquetrum and down on the lunate.
2. Observe the patient’s hand for tenderness and pain.
3. Repeat this movement and observation on the patient’s other hand for comparison.

Related Signs and Tests

• Magnetic resonance imaging (MRI)

Diagnostic Performance Characteristics

• This test has limited reliability. 

• A positive result occurs when the patient experiences motion between the triquetrum and the lunate, resulting in tenderness and/or pain.

• A negative result occurs when the patient does not experience motion between the triquetrum and the lunate.

• In many cases, LT ligament tears may become asymptomatic without formal treatment.
• Imaging studies are useful to confirm diagnoses and guide appropriate treatment. 

1. Atkinson CT, Watson J. Lunotriquetral ligament tears. J Hand Surg Am 2012;37:2142-4. PMID: 22633232
2. Culp R, Jacoby S.  Musculoskeletal Examination of the Elbow, Wrist and Hand: Making the Complex Simple. New Jersey: SLACK Incorporated, 2012.
3. Tanaka T, Ogino S, Yoshioka H. Ligamentous Injuries of the wrist. Semin Musculoskelet Radiol 2008;12(4):359-77. PMID: 19016398