PRESS TEST FOR OFFICE DIAGNOSIS OF TRIANGULAR FIBROCARTILAGE COMPLEX TEARS OF THE WRIST

We present a simple provocative diagnostic office test for detection o f triangular fibrocartilage complex tears of the wrist. Twenty-seven p atients with a working diagnosis of a triangular fibrocartilage comple x tear complained of wrist pain caused by forceful use; 18 had a histo ry of trauma. A ''press test'' was performed in each, requiring the se ated patient to push the body weight up off a chair using the affected wrist, creating an axial ulnar load. A positive test provoked focal u lnar wrist pain replicating the discomfort that had prompted the patie nt to seek medical attention. Thirteen patients improved with conserva tive treatment, Seventeen underwent magnetic resonance imaging (showin g 13 tears and 4 normal results) and two patients had arthrograms (bot h had tears), Fourteen patients had wrist arthroscopy; all had triangu lar fibrocartilage complex tears, which were debrided, with postoperat ive clinical improvement. As verified by arthroscopy, the press test h ad 100% sensitivity in preoperative tear detection compared with 79% f or magnetic resonance imaging. The press test is recommended as a usef ul, free, noninvasive clinical test for triangular fibrocartilage comp lex tears of the wrist.