Arch Hand Microsurg.  2020 Dec;25(4):259-266. 10.12790/ahm.20.0066.

The Diagnostic Value of the Ulnocarpal Stress Test for Differentiating the Symptomatic Triangular Fibrocartilage Complex Tear from the Incidental Tear

• Kim CU
• Kim DH
• Kwon BC

• KMID: 2508938
• DOI: http://doi.org/10.12790/ahm.20.0066

Abstract

Purpose
The purpose of this study was to determine the diagnostic value of the ulnocarpal stress test (UCST) for differentiating the symptomatic triangular fibrocartilage complex (TFCC) tear from the incidental tear.
Methods
From January 2013 to May 2020, a study was performed on 109 patients who underwent wrist arthroscopy and showed TFCC tear. Patients who had ulnar-sided wrist pain along with TFCC tear, and showed postoperative symptom improvement, and those with other lesions excluded were defined as symptomatic tear (experimental group) and the rest were defined as asymptomatic tear (control group). Diagnostic values of the UCST for differentiating the symptomatic TFCC tear from the incidental tear were calculated.
Results
The UCST showed a sensitivity of 54%, a specificity of 95%, a positive predictive value of 98%, a negative predictive value of 31%, a positive likelihood ratio of 10.34, a negative likelihood ratio of 0.48, and an overall diagnostic accuracy of 61%.
Conclusion
The UCST showed limited diagnostic value for symptomatic TFCC tear. Therefore, this test needs to be regarded as a part of diagnostic process and their results should be interpreted in the context of other relevant clinical information before reaching the diagnosis of symptomatic TFCC tear.

Keyword

Triangular fibrocartilage; Tear; Diagnosis; Ulnocarpal stress test

Figure

• 

  Fig. 1. STARD flow diagram of the study. UCST, ulnocarpal stress test; PRWE, patient-related wrist evaluation; TFCC, triangular fibrocartilage complex.

Reference

1. Palmer AK, Werner FW. The triangular fibrocartilage complex of the wrist: anatomy and function. J Hand Surg Am. 1981; 6:153–62.

2. Henry MH. Management of acute triangular fibrocartilage complex injury of the wrist. J Am Acad Orthop Surg. 2008; 16:320–9.

3. Mikić ZD. Age changes in the triangular fibrocartilage of the wrist joint. J Anat. 1978; 126:367–84.

4. Viegas SF, Patterson RM, Hokanson JA, Davis J. Wrist anatomy: incidence, distribution, and correlation of anatomic variations, tears, and arthrosis. J Hand Surg Am. 1993; 18:463–75.

5. Sammer DM, Rizzo M. Ulnar impaction. Hand Clin. 2010; 26:549–57.

6. Nakamura R, Horii E, Imaeda T, Nakao E, Kato H, Watanabe K. The ulnocarpal stress test in the diagnosis of ulnar-sided wrist pain. J Hand Surg Br. 1997; 22:719–23.

7. Schmauss D, Pöhlmann S, Lohmeyer JA, Germann G, Bickert B, Megerle K. Clinical tests and magnetic resonance imaging have limited diagnostic value for triangular fibrocartilaginous complex lesions. Arch Orthop Trauma Surg. 2016; 136:873–80.

8. Palmer AK. Triangular fibrocartilage complex lesions: a classification. J Hand Surg Am. 1989; 14:594–606.

9. Atzei A, Luchetti R. Foveal TFCC tear classification and treatment. Hand Clin. 2011; 27:263–72.

10. Ruch DS, Yang CC, Smith BP. Results of acute arthroscopically repaired triangular fibrocartilage complex injuries associated with intra-articular distal radius fractures. Arthroscopy. 2003; 19:511–6.

11. Geissler WB, Freeland AE, Savoie FH, McIntyre LW, Whipple TL. Intracarpal soft-tissue lesions associated with an intra-articular fracture of the distal end of the radius. J Bone Joint Surg Am. 1996; 78:357–65.

12. Halkin A, Reichman J, Schwaber M, Paltiel O, Brezis M. Likelihood ratios: getting diagnostic testing into perspective. QJM. 1998; 91:247–58.

13. Prosser R, Harvey L, Lastayo P, Hargreaves I, Scougall P, Herbert RD. Provocative wrist tests and MRI are of limited diagnostic value for suspected wrist ligament injuries: a cross-sectional study. J Physiother. 2011; 57:247–53.

14. Šimundić AM. Measures of diagnostic accuracy: basic definitions. EJIFCC. 2009; 19:203–11.

15. Wainner RS, Fritz JM, Irrgang JJ, Boninger ML, Delitto A, Allison S. Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy. Spine (Phila Pa 1976). 2003; 28:52–62.

16. Metz VM, Schratter M, Dock WI, et al. Age-associated changes of the triangular fibrocartilage of the wrist: evaluation of the diagnostic performance of MR imaging. Radiology. 1992; 184:217–20.

17. Sugimoto H, Shinozaki T, Ohsawa T. Triangular fibrocartilage in asymptomatic subjects: investigation of abnormal MR signal intensity. Radiology. 1994; 191:193–7.

18. Iordache SD, Rowan R, Garvin GJ, Osman S, Grewal R, Faber KJ. Prevalence of triangular fibrocartilage complex abnormalities on MRI scans of asymptomatic wrists. J Hand Surg Am. 2012; 37:98–103.

19. Alonzo TA, Pepe MS. Using a combination of reference tests to assess the accuracy of a new diagnostic test. Stat Med. 1999; 18:2987–3003.

20. Ruston J, Konan S, Rubinraut E, Sorene E. Diagnostic accuracy of clinical examination and magnetic resonance imaging for common articular wrist pathology. Acta Orthop Belg. 2013; 79:375–80.

21. LaStayo P, Howell J. Clinical provocative tests used in evaluating wrist pain: a descriptive study. J Hand Ther. 1995; 8:10–7.

22. Reitsma JB, Rutjes AW, Khan KS, Coomarasamy A, Bossuyt PM. A review of solutions for diagnostic accuracy studies with an imperfect or missing reference standard. J Clin Epidemiol. 2009; 62:797–806.

23. Schmidt RL, Factor RE. Understanding sources of bias in diagnostic accuracy studies. Arch Pathol Lab Med. 2013; 137:558–65.

24. Boyer K, Wies J, Turkelson CM. Effects of bias on the results of diagnostic studies of carpal tunnel syndrome. J Hand Surg Am. 2009; 34:1006–13.

25. van Stralen KJ, Stel VS, Reitsma JB, Dekker FW, Zoccali C, Jager KJ. Diagnostic methods I: sensitivity, specificity, and other measures of accuracy. Kidney Int. 2009; 75:1257–63.