From the Guidelines
The diagnosis of triangular fibrocartilage complex (TFCC) injury should rely on a combination of clinical examination and imaging studies, with CT arthrography being the most sensitive and specific imaging modality, as evidenced by a recent study 1. The clinical examination should include the ulnar fovea sign, piano key test, and TFCC compression test, as well as provocative maneuvers like the press test. Imaging begins with plain radiographs to rule out fractures or ulnar variance abnormalities. However, for the diagnosis of TFCC injuries, CT arthrography is preferred over MRI, with a sensitivity and specificity of 92-94% for TFCC tears, as reported in a 2024 study 1. Wrist arthroscopy remains the definitive diagnostic tool, allowing direct visualization and classification of tears, and can simultaneously serve as a therapeutic intervention. Early diagnosis is crucial as untreated TFCC injuries can lead to chronic instability, arthritis, and decreased grip strength. Some studies suggest that MR arthrography can also be useful, with a higher sensitivity and specificity for the detection of scapholunate ligament injury, lunotriquetral ligament injury, and TFC injury 1, but CT arthrography is the most recent and highest quality study recommended for TFCC injury diagnosis. Key points to consider in the diagnosis of TFCC injury include:
- Clinical examination: ulnar fovea sign, piano key test, TFCC compression test, and press test
- Imaging: plain radiographs, CT arthrography, and potentially MR arthrography
- Definitive diagnosis: wrist arthroscopy
- Importance of early diagnosis to prevent chronic instability, arthritis, and decreased grip strength.
From the Research
Diagnostic Criteria for TFCC Injury
The diagnostic criteria for TFCC injury involve a combination of clinical examination, history, and diagnostic imaging. The following points highlight the key aspects of diagnosing TFCC injuries:
- Clinical presentation: TFCC tears can result in persistent ulnar-sided wrist pain, especially during forearm rotation 2, 3.
- Diagnostic imaging: Various imaging modalities are used to diagnose TFCC injuries, including:
- Magnetic Resonance Imaging (MRI): Provides superior contrast resolution and is useful for visualizing the TFCC cartilage and ligaments 4, 5.
- Magnetic Resonance Arthrography (MRA): Accurately visualizes structural abnormalities of the TFCC and has equivalent sensitivity and specificity to Computed Tomography Arthrography (CTA) 6, 5.
- Ultrasound: Useful for visualizing intra-articular effusion, soft tissue, and bone surface, but has limited accuracy in diagnosing TFCC lesions 5.
- Computed Tomography (CT)/Computed Tomographic Arthrography (CTA): Has high sensitivity and specificity for diagnosing TFCC injuries, especially central TFCC lesions 6.
- Classification of TFCC injuries: Acute and chronic TFCC tears can be classified based on their location, size, and severity, which guides treatment decisions 2, 3.
- History and physical examination: A thorough clinical evaluation is essential for diagnosing TFCC injuries, including assessment of wrist pain, tenderness, and instability 2, 3.