Trauma can result in triangular fibrocartilage tears, and it is not necessary that it is always secondary to injuries of the foveal attachment. It can be secondary to injuries or tears of other segments of the TFCC and may cause some degree of laxity of the DRUJ and pain.
In this study we review a single cohort of patients with ulnar sided wrist pain who had needed operative management to evaluate the association of clinical findings, arthroscopic investigation with the incidence of various type of TFCC tears.
A retrospective review was conducted in 80 patients presenting with ulnar sided wrist pain who underwent clinical examination followed by arthroscopic management. Clinical records and arthroscopy videos were reviewed by the surgeon and the findings were recorded.
73 of the 80 patients had a positive ulnar foveal sign. All patients had varying degrees of laxity of the DRUJ. All patients underwent wrist arthroscopy and a successful inspection of the foveal attachment and the TFCC. Only 21 patients had a foveal tear whereas the rest had tears of various degrees of the periphery and central aspect of the triangular fibrocartilage complex. The hook test was present in nearly all foveal tears and large tears of the dorsal periphery. The trampoline test was nearly positive in all the tears and in 57% of foveal tears.
The following is a preliminary interpretation of our data to formulate an algorithm: A positive Fovea sign is more frequently due to tears in the dorsosulnar periphery of the TFCC than foveal tears. Severe laxity of the DRUJ is nearly always present in complete disruption of the foveal fibers. The hook test is present in nearly all foveal tears and large dorsal peripheral tears. The absence of a trampoline test in the presence of mild laxity in such cases has a higher probability of an incomplete foveal tear than a large peripheral tear. Absence of the Hook test, in the presence of slight laxity and a positive trampoline test is more likely secondary to a dorsal peripheral tear of normal caliber.
