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TFCC: Examination

- See: Ligaments of the Wrist

- Exam of TFCC Injury:
    - tenderness is usually centered about dorsal depression distal to ulnar head, or it may be localized around the ulnar styloid;
           - patients may also note tenderness between the triquetrum and the ulnar styloid;
    - passive manipulation of the carpus against the head of the ulna w/ wrist in ulnar deviation usually causes pain;
           - tenderness against resisted radial deviation will also cause tenderness;
           - this should be differentiated from the click of midcarpal instability;
    - patients will TFCC tears, often show pain w/ forced forearm pronation and supination or pain with gripping and ulnar deviation;
    - pts w/ TFCC tears that are symptomatic often note a painful click during wrist motions;
           - have the patient clench and ulnary deviate the wrist, and then repeatedlly pronate and supinate the wrist;
           - in contrast, patients w/ SLD will have pain and a click when the clenched fist is moved from ulnar to radial deviation;
    - ulnar impaction test: pain w/ wrist hyperextension and ulnar deviation with axial compression;
    - piano key sign: (for instability);
           - laxity or instability of the R-U joint w/ controled dorsal palmar shucking;
           - DRUJ is tested w/ forearm in neutral position
           - examiner tries to force the radius manually in dorsal and palmar directions versus the ulna;
           - instability and pain are judged relative to the contralateral side;
           - when this test is positive (as compared to opposite wrist), then RU intability is present;
           - this test can be helpful in diagnosing a complete peripheral tear of the TFCC;
                  - sensitivity (0.59), the specificity (0.96), the positive predictive value (0.91), and the negative predictive value;
                  - ref: Peripheral tears of the triangular fibrocartilage complex cause distal radioulnar joint instability after distal radial fractures.  

The "ulnar fovea sign" for defining ulnar wrist pain: an analysis of sensitivity and specificity.