Wrist & Hand Assessment

Fovea Sign | Triangular Fibrocartilage Complex (TFCC) Exam

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Fovea sign

Fovea Sign | Triangular Fibrocartilage Complex (TFCC) Exam

The triangular fibrocartilage complex, abbreviated as TFCC consists of the articular disc, the meniscus homologue, the dorsal and palmar radioulnar ligaments, the ulnolunate and ulnotriquetral ligaments, and the extensor carpi ulnaris tendon sheath.

As a center of forearm rotation, the TFCC plays a key role in stabilization, rotation, translation, loading transmission to the wrist and acts as an essential pivot point. Due to its anatomical location as well as its involvement in the key functions of rotation and load bearing, it is highly prone to injuries and attritional wear.

Schmauss et al. (2016) have examined the fovea sign regarding its clinical accuracy in 908 patients suspected to have TFCC lesions. The authors found a sensitivity of 73% and a specificity of 44%. Results varied slightly depending on the Palmer classification. The Palmar classification divides TFCC lesions into traumatic and degenerative origin and into location and kind of lesion.

Palmer classification tfcc lesions
Palmer classification tfcc with picture
Rekant et al. (2019)

Due to the poor accuracy of this test, the diagnostic value of this test is rather weak. Interestingly, MRI imaging did not perform better and reached a comparably high level of sensitivity and poor specificity in this study.

For the ulnar fovea sign test, the examiner palpates the soft spot between the ulnar styloid, the flexor carpi ulnaris tendon, the volar surface of the ulnar head and the pisiform (Fig. 2). 

Reproducible pain at this spot, as compared with the contralateral side, resembles a ‘‘positive’’ ulnar fovea sign

21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE

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Other orthopedic tests for the triangular fibrocartilage complex are:

Other common tests for injuries at the wrist are:

 

References

Schmauss, D., Pöhlmann, S., Lohmeyer, J. A., Germann, G., Bickert, B., & Megerle, K. (2016). Clinical tests and magnetic resonance imaging have limited diagnostic value for triangular fibrocartilaginous complex lesions. Archives of orthopaedic and trauma surgery136(6), 873-880.

Rekant, M. (2019). Injuries to the Triangular Fibrocartilage Complex. In Sports Injuries of the Hand and Wrist (pp. 235-253). Springer, Cham.

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