How to test the Triangular Fibrocartilage Complex (TFCC)?

From the Guidelines

To test for a triangular fibrocartilage complex (TFCC) injury, the most direct approach is to perform MR arthrography, as it has the highest sensitivity and specificity for detecting TFCC tears and other wrist abnormalities, as supported by the most recent study 1. The TFCC Compression Test, Ulnar Fovea Sign Test, and Piano Key Test are physical examination maneuvers that can suggest a TFCC tear, but are not definitive diagnostic tools.

• The TFCC Compression Test involves applying pressure to the ulnar side of the wrist while rotating the forearm, with pain during this maneuver suggesting a TFCC tear.
• The Ulnar Fovea Sign Test applies pressure to the ulnar fovea, which can also elicit pain in TFCC injuries.
• The Piano Key Test involves pressing down on the distal ulna to check for abnormal movement and pain. For more definitive diagnosis, imaging studies are necessary, with MR arthrography being the preferred method due to its high sensitivity and specificity, as noted in the study 1.
• MR arthrography has a sensitivity ranging from 63% to 100% and specificity ranging from 89% to 97% for detecting TFC tears, intrinsic ligament injury, and cartilage lesions of the radiocarpal joint.
• Wrist traction can improve the detection of cartilage, TFC, and intrinsic ligament injuries, as mentioned in the study 1. Other imaging options, such as CT arthrography, may also be considered, but MR arthrography is generally preferred due to its higher diagnostic accuracy, as supported by the study 1.
• CT arthrography has demonstrated a sensitivity, specificity, and accuracy between 92% and 94% for triangular fibrocartilage complex tears, but may not provide as much detail as MR arthrography. Wrist arthroscopy remains the definitive diagnostic tool, allowing direct visualization and simultaneous treatment of TFCC tears, but is typically reserved for cases where other diagnostic methods are inconclusive or when surgical intervention is planned.

From the Research

Testing TFCC

To test the Triangular Fibrocartilage Complex (TFCC), several diagnostic imaging modalities can be used, including:

• Magnetic Resonance Imaging (MRI) 2
• Magnetic Resonance Arthrography (MRA) 3, 4, 2
• Computed Tomography (CT)/Computed Tomographic Arthrography (CTA) 4
• X-ray Arthrography 5

Diagnostic Accuracy

The diagnostic accuracy of these imaging modalities varies:

• MRI: pooled sensitivity of 0.76 and specificity of 0.82 4
• MRA: pooled sensitivity of 0.78 and specificity of 0.85 4
• CT Arthrography: pooled sensitivity of 0.89 and specificity of 0.89 4
• X-ray Arthrography: pooled sensitivity of 76.2% and specificity of 92.5% 5

Imaging Modality Selection

The choice of imaging modality depends on the specific clinical presentation and the suspected type of TFCC injury:

• MRA is recommended for the diagnosis of full-thickness TFCC tears 2
• CT Arthrography may be useful for detecting central TFCC lesions 4
• X-ray Arthrography may not be the best choice due to its limited diagnostic accuracy 5

Clinical Evaluation

Clinical evaluation, including history and physical examination, is also essential for diagnosing TFCC injuries 6

• Patients with ulnar-sided wrist pain and suspected TFCC injury should undergo a thorough clinical evaluation before undergoing diagnostic imaging 6