What provocative testing of the distal radioulnar joint (DRUJ) and triangular fibrocartilage complex (TFCC) is performed in the evaluation of ulnar-sided wrist pain?

Updated: Apr 26, 2021
  • Author: David M Lichtman, MD; Chief Editor: Harris Gellman, MD  more...
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Stress loading tests are used to assess the stability of the distal radioulnar joint (DRUJ)/triangular fibrocartilage complex (TFCC), as well as to distinguish DRUJ/TFCC pathology from lunotriquetral or triquetrohamate joint disease. The piano-key test involves depressing the distal ulna from dorsal to volar with the hand pronated. A positive result is characterized by painful laxity in the affected wrist compared with the contralateral wrist. The results are usually positive in cases of DRUJ synovitis.

The ulnar compression test may reveal degeneration or inflammation of the DRUJ. To perform this test, compress the ulnar head against the sigmoid notch. A positive result is exacerbation of pain, which suggests arthritis or instability. In addition, with ulnar compression, dorsal or volar subluxation may be noted.

See Clinical Presentation for a brief discussion of the ulnar fovea sign.

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