From the Guidelines
Physical examination findings for triangular fibrocartilage complex (TFCC) injuries typically include ulnar-sided wrist pain that worsens with gripping, rotation, or ulnar deviation, and can be further evaluated with provocative tests such as the ulnar fovea sign, piano key test, TFCC compression test, and ulnocarpal stress test. These tests can help diagnose TFCC injuries, which may also present with tenderness directly over the TFCC, located between the ulnar styloid and triquetrum 1. Several key findings to look for include:
- Ulnar-sided wrist pain that worsens with gripping, rotation, or ulnar deviation
- Tenderness directly over the TFCC
- Positive ulnar fovea sign, which is elicited by pressing on the soft spot between the ulnar styloid and flexor carpi ulnaris tendon
- Positive piano key test, which involves pressing down on the distal ulna to assess for excessive mobility and pain
- Positive TFCC compression test, which involves applying an axial load to the wrist while rotating it in ulnar deviation
- Positive ulnocarpal stress test, which is performed by applying pressure to the ulnar side of the wrist while moving it from radial to ulnar deviation
- Diminished grip strength compared to the unaffected side
- Positive clicking or catching sensation during wrist rotation. Advanced imaging like MR arthrography, which has a higher sensitivity and specificity for the detection of scapholunate ligament injury, lunotriquetral ligament injury, and TFC injury 1, may be needed for confirmation.
From the Research
TFCC Exam Findings
- A diligent clinical examination is necessary to allocate symptoms to the pathology of the TFCC 2
- Specific tests can be used to facilitate the diagnosis of TFCC lesions, as part of a thorough clinical examination 2
- Wrist arthroscopy is currently the "gold standard" for diagnosing TFCC pathologies 2
- MR arthrography may have the potential to become a real alternative to wrist arthroscopy for diagnosing TFCC pathologies in the future, with technical progress in imaging modalities 2