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Triangular Fibrocartilage Complex (TFCC) Tenderness

Exams and Signs

Historical Overview

  • In 1989, Palmer presented a classification of triangular fibrocartilage complex (TFCC) injuries, including traumatic and degenerative lesions. Traumatic lesions are classified by their location. Degenerative lesions are classified according to the location and the severity of changes of the TFCC, ulnar head, ulnocarpal bones and lunotriquetral ligament.1

Description

  • Patients usually experience TFCC tenderness over the dorsal or volar aspect of the TFCC.2
  • When examining patients with ulnar-sided wrist pain, it is vital to identify a potential TFCC injury with distal radioulnar joint (DRUJ) pathology.3

Pathophysiology

  • TFCC tenderness can be caused by a distal radius fracture, which may be caused by a fall on an outstretched hand (FOOSH).
  • Without treatment, traumatic TFCC injuries may lead to chronic wrist pain and eventually to DRUJ instability and posttraumatic arthritis.3
  • Degenerative TFCC tears can be caused by ulnar impaction syndrome.

Instructions

  1. Record the patient’s history, including any sports-related injuries. Ask the patient to rate how much pain s/he usually experiences in the affected wrist on a scale from 1 to 10
  2. Check for tenderness, crepitus, swelling and/or pain in the TFCC area
  3. Palpate the TFCC in the soft spot between the ulnar styloid, flexor carpi ulnaris (FCU), volar surface of the ulnar head, and pisiform4
  4. Examine the contralateral wrist for comparison

Related Signs and Tests

  • Fovea sign
  • DRUJ stability
  • ECU subluxation test
  • Ulnar deviation
  • Magnetic resonance imaging (MRI)
  • Arthroscopy

Diagnostic Performance Characteristics

  • To improve reliability, the TFCC tenderness test should be used in conjunction with the fovea sign and the volar DRUJ stability test. Arthroscopy of the wrist is usually the most effective way to diagnose ruptures of the TFCC.5
  • Do not use other patients’ reactions as a comparison, because other patients may have different perceptions of similar tenderness and/or pain.
Definition of Positive Result
  • A positive result occurs when pressure applied to the TFCC area cause increased tenderness.
Definition of Negative Result
  • A negative result occurs when pressure applied to the TFCC area does not cause increased tenderness.
Comments and Pearls
  • TFCC tears, including the ligamentous portion of the TFCC or including a flap that interposes into the joint, often result in continued tenderness and pain.3
Diagnoses Associated with Exams and Signs
References
  1. Palmer AK. Triangular fibrocartilage complex lesions: A classification. J Hand Surg Am 1989;14A:594-606. PMID: 2666492
  2. The Hand: Anatomy, Examination and Diagnosis. 4th ed. Rayan G, Akelman E (eds). Philadelphia: Lippincott Williams & Wilkins, 2011.
  3. Culp R, Jacoby S. Musculoskeletal Examination of the Elbow, Wrist and Hand: Making the Complex Simple. New Jersey: SLACK Incorporated, 2012.
  4. Sachar K. Ulnar-sided wrist pain: evaluation and treatment of triangular fibrocartilage complex tears, ulnocarpal impaction syndrome, and lunotriquetral ligament tears. J Hand Surg Am 2008;33(9):1669-79. PMID: 18984356
  5. Mannil L, Martin W, Dahmen J, et al. Arthrocsopic treatment for ulnar-sided TFCC-tears. Eur J Trauma Emerg Surg 2016;42(1):29-35. PMID: 26566794
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