All participants underwent clinical examination prior to arthroscopy. A subgroup of participants also underwent MRI investigation prior to arthroscopy. The decision to undertake an MRI investigation was made at the surgeons’ discretion. The order of the provocative tests and MRI was dictated by convenience, but both the provocative tests and MRI were completed before the arthroscopy. All provocative tests were performed as close as possible to arthroscopy. The longest delay was 21 days. Provocative tests were conducted blind to the results of MRI, and MRIs were interpreted blind to the results of the provocative tests. The surgeons performing the arthroscopies were blinded to the results

of the provocative tests but not to the results of the MRIs. Clinical examinations were performed primarily (87%) by one hand therapist (RP) with 27 years of experience. The other clinical examinations were performed by two therapists with 20 and 10 years of selleckchem experience. Initially, a subjective assessment was undertaken and included questions to determine the time of injury, location of pain, and the functional demand on the wrist. The functional demand placed on the wrist by work and activities of daily living was

classified by participants on a 3-point scale designed for this study. On this scale ‘light’ reflected sedentary or office work, ‘moderate’ reflected Microbiology inhibitor intermittent use with heavier activities such as gardening, and ‘heavy’ reflected manual work or participation in manual sports such as martial arts and racquet sports on a regular basis. Participants were also asked to self-rate perceived wrist stability on a 4-point scale designed for this study. The levels of the scale were ‘does not give way’, ‘gives way with heavy activity’, ‘gives way with moderate activity’, and ‘gives way with light activity’. Pain and function were assessed with the Patient-Rated Wrist and Oxalosuccinic acid Hand Evaluation questionnaire (MacDermid and Tottenham, 2004). The physical examination consisted of an assessment of the integrity of various wrist ligaments, the TFCC, and the lunate

cartilage. The tests used were the SS test, LT test, MC test, TFCC test, TFCC comp test, DRUJ test, and the GRIT (LaStayo and Weiss, 2001). Both asymptomatic and symptomatic wrists were tested to establish if there was hypermobility in the symptomatic wrist with respect to the asymptomatic wrist and to determine if there was pain. The outcomes of tests were reported as positive, negative or uncertain except for the GRIT which was only reported as positive or negative. A test was only reported as positive if it reproduced the participant’s pain (with or without hypermobility compared to the contralateral side). A test was reported as uncertain if there was hypermobility (compared to the contralateral side) or if the pain produced was not the primary pain that the participant presented with.