Some diagnositic tests that can be performed during a physical examination include:
The McMurray’s test: when the examiner glides the lunate and triquetrum up and down in the wrist, while the wrist is bent on the little finger side (ulnarly deviated). Usually if there is a TFCC tear, the patient should feel pain, crepitus and or a painful snapping. (8)Piano key test: the examiner gently moves up and down the wrist end of the ulnar, while holding onto the radius. The ulnar is pressed down, like a piano key and normally the ular should spring back like a piano key, but in the event of a TFCC tear the ulna may move more than usual and may not spring back up like normal.
Load Test: the examiner grips the patient’s hand in a ‘hand shake position’ and ulnarly deviates the wrist, thereby squashing the TFCC. While still compressing the complex, the examiner rotates the wrist through an arc to feel for crepitus, clicking and see whether the patient feels an pain.
A more functional test is the "press test," in which the patient is instructed to lift themselves out of a chair by pushing off the chair’s arm rests. This test is very sensitive in picking up TFCC tears and is an easy technique to perform (5).
Some other imaging techniques that may be used to complement wrist arthroscopy:
Research today suggests wrist arthroscopy is the best imaging technique to determine the presence and severity of a TFCC tear.(6, 12). To read more information on wrist arthroscopy, view post on 'surgical management' below.
Xray - may illustrate TFCC disruption, in the presence of a fracture, otherwise TFCC tears will go unnoticed on a plain film. Changes associated with a TFCC tear such as ulnar variance or dislocations may be evident from a plain film X-ray, which may suggest a TFCC lesion, but is not conclusive on its own.
MRI - can be used to indicate the presence of a TFCC tear and was used alot in the past, but more recent research suggests it is not as good as an arthrogram or arthroscopy in diagnosing TFCC tears. MRI images can be useful in differentiating the class of TFCC tear as class 1 tears (traumatic in origin) appear more obvious in T2 or fat saturated images, while class 2 tears appear as a high signal area in all T1, T2 weighted and fat saturated images (8).
Fig 4. Class 2B. T2 weighted MRI indicates thinning and perforation of the central segment (arrows).
Arthrogram – Dye is injected into the wrist joint to see whether there is a tear of the TFCC. If there is a tear, dye will leak into the surrounding joints. There are 3 main joints and normally these joints are closed off from one another. Nonetheless this method has its faults. In the presence of severe scarring after a TFCC tear, an arthrogram may appear negative, as the scar tissue blocks the tear, stopping the dye from leaking into the other joints. Also some people’s wrist joint are normally not completely closed off from eachother and therefore may falsely indicate a positive arthrogram. Today arthrography is being replaced by arthroscopy, which is the standard by which other techniques used to diagnose ulnar sided wrist pain, are be compared (12).
