What is the squeeze test as it relates to joint pain and how is it performed?

The Squeeze Test for Joint Pain

What is the Squeeze Test?

The squeeze test is a simple clinical maneuver that involves applying lateral compression across multiple joints simultaneously to detect inflammation, and it is performed differently depending on the anatomical location being examined. 1

How to Perform the Squeeze Test

For Hand Joints (Metacarpophalangeal/MCP)

• Apply lateral compression across the MCP joints by squeezing the hand from side to side across multiple joints simultaneously 1, 2
• The test is considered positive when this compression elicits pain 1, 3
• Involvement of hand joints is suggested by a positive squeeze test 1

For Foot Joints (Metatarsophalangeal/MTP)

• Apply lateral compression across the MTP joints by squeezing the forefoot from side to side 1, 2
• Similar to the hand test, pain upon compression indicates a positive result 1, 3
• Involvement of foot joints is suggested by a positive squeeze test 1

For Ankle (Syndesmotic Injury)

• Apply compression to the mid-calf by squeezing the tibia and fibula together 4, 5
• The test is positive when proximal compression of the calf produces pain in the area of the distal tibiofibular and interosseous ligaments 4
• This squeezing causes separation of the distal fibula and tibia, stressing the syndesmotic ligaments 4
• The squeeze test for ankle syndesmosis has high specificity (88%) but should be combined with other tests for optimal diagnostic accuracy 5

Clinical Significance and Diagnostic Performance

For Arthritis Detection (MCP/MTP Joints)

• A positive squeeze test is associated with local joint inflammation, but the sensitivity is low (53-54%), indicating many swollen joints will have a negative test 3
• The specificity is moderate to good (74-82% for MCP/MTP joints respectively) 3
• When positive, the test has a positive likelihood ratio of 2.1-3.0, modestly increasing the probability of arthritis 3

What the Test Actually Detects

• In early arthritis patients with a positive MTP squeeze test, 79% had either synovitis or intermetatarsal bursitis (IMB): 12% had synovitis alone, 15% had IMB alone, and 52% had both 6
• This demonstrates that the squeeze test detects not only intra-articular inflammation (synovitis) but also juxta-articular inflammation (IMB and tenosynovitis) 6
• Both synovitis and IMB independently associate with squeeze test positivity in multivariable analysis 6

Clinical Application Algorithm

When to Use the Squeeze Test

• Use as a screening tool when arthritis involving multiple joints is suspected, particularly when evaluating for early rheumatoid arthritis 1
• The test should be part of the physical examination when patients present with joint swelling associated with pain or stiffness 1

Interpreting Results

• A positive test (pain on compression) increases suspicion for arthritis and warrants further evaluation, but a negative test does NOT rule out arthritis 3
• Consider the test most useful when positive at 3 or more sites, as this indicates both symmetry and hand/foot involvement 2
• The test performs better when combined with other clinical findings rather than used in isolation 3, 5

Critical Pitfalls to Avoid

• Do not rely on the squeeze test alone to diagnose or exclude arthritis—it has insufficient accuracy when used as a standalone test 3
• The high false-negative rate (sensitivity 53-54%) means many patients with genuine joint inflammation will have a negative test 3
• For ankle syndesmosis injury, combine the squeeze test with other sensitive tests (syndesmosis ligament tenderness, dorsiflexion-external rotation stress test) for optimal diagnostic accuracy 5
• Remember that a positive MTP squeeze test may reflect intermetatarsal bursitis rather than true joint synovitis 6