What are the clinical examination findings for a Triangular Fibrocartilage Complex (TFCC) tear?

From the Guidelines

The clinical examination for a triangular fibrocartilage complex (TFCC) tear should include a combination of inspection, palpation, and provocative tests, such as the ulnocarpal stress test, piano key test, press test, and fovea sign, to reproduce pain and assess stability, as these tests have been shown to be effective in identifying TFCC injuries 1. The examination should begin with inspection for ulnar-sided wrist swelling or deformity, followed by palpation directly over the TFCC between the ulnar styloid and triquetrum, which typically elicits pain in TFCC injuries.

• The ulnocarpal stress test involves applying axial load and ulnar deviation while rotating the forearm, producing pain with TFCC pathology.
• The piano key test assesses distal radioulnar joint stability by pressing on the distal ulna to detect abnormal movement.
• The press test, where the patient pushes up from a seated position, can reproduce symptoms.
• The fovea sign, involving deep palpation between the ulnar styloid and flexor carpi ulnaris tendon, is highly specific for TFCC tears when positive. Range of motion testing often reveals pain with ulnar deviation and forearm rotation. While these tests help identify TFCC injuries, they should be interpreted alongside the patient's history and imaging studies, such as MR arthrography, which has been shown to have high sensitivity and specificity for detecting TFCC tears 1, and can provide valuable information for definitive diagnosis and treatment planning.

From the Research

Clinical Exam for TFCC Tear

• The clinical assessment of a TFCC tear involves patient history and physical examination 2
• Imaging modalities like MRI are also used in the clinical assessment of TFCC tears 2
• Wrist arthroscopy is considered the gold standard for diagnosing TFCC tears 2

Key Components of Clinical Exam

• Patient history: to understand the mechanism of injury and symptoms 2
• Physical examination: to evaluate wrist stability and pain 2
• Imaging modalities: to confirm the diagnosis and classify the tear 2

Classification and Treatment

• Multiple classification systems categorize TFCC tears based on location and arthroscopic appearance, guiding treatment decisions 2
• Surgical options are recommended for tears refractory to conservative management or severe tears 2