Hand Surgery Source

Table-Top Test

Test, Exam and Signs

Historical Overview

  • A table-top test is used to diagnose Dupuytren’s contracture.1
  • Although the disorder was previously observed and treated by others, the condition was named after Dupuytren, as he was the first to perform corrective open fasciotomy and to widely instruct other surgeons in the procedure.2

Description

  • A patient’s inability to place their palm and fingers flat on a table is highly indicative of Dupuytren’s contracture.

Pathophysiology

  • For reasons not currently understood, the palmar fascia thickens to form a nodule and then a cord, which attaches to the ligamentous structures of the digits. The cord then tighten and force the affected joint(s) into flexion.3

Instructions

  1. Take a patient history
  2. Instruct the patient to lay their palm and digits flat onto a table top.

Related Signs and Tests

  • Dupuytren’s contracture
  • Notta’s node

Diagnostic Performance Characteristics

  • A positive table top test is highly suggestive of Depuytren’s although trigger digits should be considered in differential diagnosis.
Presentation Photos and Related Diagrams
  • Table Top Test - The hand can not go flat because of MP contractures caused by Dupuytren's Disease.
    Table Top Test - The hand can not go flat because of MP contractures caused by Dupuytren's Disease.
  • Dupuytren's Cords limiting left long and ring and right little finger extension which will cause positive Table Top Tests (TTT).
    Dupuytren's Cords limiting left long and ring and right little finger extension which will cause positive Table Top Tests (TTT).
  • Positive right Table Top Test (TTT).
    Positive right Table Top Test (TTT).
  • Positive left Table Top Test (TTT).
    Positive left Table Top Test (TTT).
  • Negative right Table Top Test (TTT).
    Negative right Table Top Test (TTT).
Definition of Positive Result
  • A positive test occurs when the patient cannot flatten the palmar side of his/her hand onto the surface of a table.
Definition of Negative Result
  • A negative result occurs when a patient can flatten the palmar side of his/her hand onto the surface of a table.
Comments and Pearls
  • Dupuytren’s disease is most common in white men of northern European ancestry, and prevalence increases with age.3
  • The cause of Dupuytren’s disease is much debated but, as yet, unknown.3
Diagnoses Associated with Tests, Exams and Signs
References
  1. Dupuytren G. Permanent retraction of the fingers, produced by an affection of the palmar fascia. Lancet 1834;22:222–5.
  2. Desai SS, Hentz VR. The treatment of Dupuytren disease. J Hand Surg Am 2011;36(5):936-942.  PMID: 21527148
  3. Bayat A, McGrouther DA. Management of Dupuytren's disease--clear advice for an elusive condition. Ann R Coll Surg Engl 2006;88(1):3-8. PMID: 16460628