Radiographs: may reveal avulsion of ulnar styloid, scaphoid fracture, distal radial fracture, volar tilt of lunate or triquetrum; ulnar variance. The last proactive test is called the “pressed” test. The client sits on a chair with hands grasping the edges of chair. The client is directed to weight bear on extended wrists as they push themselves up off of the chair. If pain in ulnar region occurs, the test is considered positive. One of the serious complications is potential injury to the dorsal sensory branch of ulnar nerve. It can be prevented by careful dissection techniques and handling of the nerve after exposure. Knowledge of variation of position of the nerve with forearm rotation reduces the risk of nerve injury. Neuro-praxia of the dorsal sensory branch of ulnar nerve is usually transient and recovers spontaneously in 3–4 months. Recovery after surgery varies, but typically four to six weeks should be expected for arthroscopy and approximately three months for an open approach. Patients will undergo physical therapy after the procedure. The exact time to begin physical therapy and the length of physical therapy depends on the type of surgery performed and the surgeon’s preference. [2]

Ulnar extensor or flexor muscle tendonitis: Movements that cause the muscle to fire will provoke the pain. Pain may radiate along the muscle belly depending on the degree of inflammation. Small changes in ulnar length have been shown to have substantial effects on the amount of load to the ulna. The TFCC compression test is performed by ulnar deviating the forearm in neutral rotation. Reproduction of symptoms indicates that the test is positive In the TFCC stress test an axial load is applied to a ulnar-deviated wrist which produces pain and discomfort. The piano key test is done to assess the stability of the DRUJ. It is done in pronated position of forearm. With the hand being stabilized, the dorsal ulnar prominence relative to radius is observed and the ulnar head in pushed volarly. A positive piano key sign is noted when minimal amount of resistance is felt againt volar displacement of ulnar head, suggesting the presence of underlying DRUJ instability. The test should be repeated with the forearm in supination. Comparision of the amount of ulnar displacement must be done with contralateral side because patients with generalized ligamentous laxity may have a substantial amount of abnormal baseline displacement.Supination test: Patient grabs the underside of a table with the forearms supinated; this causes a load on the TFCC and dorsal impingement, which will cause pain if there is a peripheral, dorsal tear. Rettig AC, Athletic Injuries of the wrist and hand, part 1: traumatic injuries of the wrist. Am J Sports Med 2003:31(6):1038-48 Leger AB, Milner TE. , Muscle function at the wrist after eccentric exercise, Medicine and Science in Sports and Exercise, 2001;33:612–20.

Function of TFCC: Main stabilizer of distal radioulnar joint (volar portion of TFCC prevents dorsal displacement of ulna and is tight in pronation and dorsal portion of TFCC prevents volar displacement of ulna and is tight in supination). Contributes to ulnocarpal stability [4] [5] Examination of a suspected TFCC injured patient requires careful palpation and application of few provocative tests. The patient must be seated in a relaxed environment and should be explained to report any discomfort or reproduction of symptoms during the process of examination. All tests must be performed on the uninjured limb first, this serves in two ways. One, it acts as a control for comparision, two, it alleviates apprehension in an anxious patient. Traumatic and Degenerative .This classification provides an accurate anatomic description of tears, it does not guide treatment or indicate prognosis If you have a client who presents with a TFCC injury, one may experience one or more of the following symptoms: On exam, palpation of the TFCC is best with the wrist in pronation. It is between the flexor carpi ulnaris, ulnar styloid, and os pisiform. Several physical exam tests can suggest the diagnosis of TFCC injury. These include:

Beta Wrist Brace for Tenosynovitis

Hogrefe, C. (2016). Wrist-TFCC Compression Test. Retrieved from https://www.youtube.com/watch?v=8Ru0RUsEoKc If the patient does not improve under conservative management, the next step is a surgical consultation obtained in a timely fashion.

Other instances that may cause an acute injury or tear of your TFCC include falling on your wrist, twisting your wrist while weight-bearing, fracturing your wrist, and degeneration of the tissues as you age. These injuries and tears result in pain on the ulnar "pinky" side of your hand.Wrist mobility in all planes (flexion, extension, supination, pronation, radial and ulnar deviation), pain free or limited pain Tears can be located in the ulnar or central portion of the ligament. Depending on the severity of the tear they are typically done either athroscopically or open. The rehab varies based on the type of repair and the amount of initial damage.