Triangular Fibrocartilage Complex Injuries Clinical Presentation

Updated: Oct 13, 2022
  • Author: James R Verheyden, MD; Chief Editor: Harris Gellman, MD  more...
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The history of triangular fibrocartilage complex (TFCC) injuries includes ulnar-side wrist pain (frequently accompanied by clicking), a fall or trauma, and/or mechanical symptoms that improve with rest and worsen with activity.


Physical Examination

In the physical examination, it is important to look for the following:

  • Painful grinding or clicking with wrist range of motion (ROM)
  • Weakness
  • Ulnar deviation of the wrist with the forearm in neutral produces ulnar wrist pain and occasional clicking (perform a TFCC compression test)
  • Instability of the distal radioulnar joint (DRUJ) joint with shucking the distal radius and ulna between the examiner's fingers (perform a DRUJ stress test; always compare this with the opposite wrist)
  • Piano key sign, which is a prominent and ballottable distal ulna with full pronation of the forearm
  • Ulnar carpal sag
  • Lunotriquetral (LT) interval tenderness
  • Positive LT ballottement or shuck test
  • Extensor carpi ulnaris (ECU) tendon subluxation