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MTP Drawer Test

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Other Names

  • Vertical stress test
  • Hamilton-Thompson test
  • Metatarsophalangeal Drawer Test
  • Digital Drawer Sign
  • Lachman Test Toe

Purpose

MTP Drawer Test
Illustration of the MTP Drawer Test[1]
Illustration of grading system[2]
  • Assess MTP joint instability

Description

  • Examiner grasps metatarsal head with one hand and the proximal phalanx with the other
  • The examiner attempts to dislocate the proximal phalanx dorsally
  • Positive test
    • Reproduction of the patient’s pain
  • Can stratifies the severity of MTPJ instability using a 0 to 4 scale
    • Direct correlation between the magnitude of the instability and the grade of the plantar plate lesion.
    • Grade 0 = stable joint
    • Grade 1 to 2 = subluxable
    • Grade 3 = dislocatable
    • Grade 4 = dislocated

Pathology


Evidence

  • Klein et al[3]
    • Sensitivity: 80.6%
    • Specificity: 99.8%

See Also


References

  1. de Avila Fernandes, Eloy, et al. "Can ultrasound of plantar plate have normal appearance with a positive drawer test?." European journal of radiology 84.3 (2015): 443-449.
  2. Nery, Caio, et al. "Plantar plate radiofrequency and Weil osteotomy for subtle metatarsophalangeal joint instablity." Journal of orthopaedic surgery and research 10.1 (2015): 1-8.
  3. Klein EE, WeilL Jr, WeilL SSr, Coughlin MJ, Knight J. Clinical examination of plantar plate abnormality: a diagnostic perspective. Foot Ankle Int 2013;34(6):800—4.
Created by:
John Kiel on 31 January 2022 06:04:59
Authors:
Last edited:
19 April 2023 23:05:50
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