The TFCC table lift test: A clinical tool for detecting palmer 1B TFCC lesions

Ulnar-sided wrist pain, frequently linked to triangular fibrocartilage complex (TFCC) injuries, poses a diagnostic challenge due to the limited sensitivity and specificity of standard clinical tests. Although wrist arthroscopy remains the diagnostic gold standard, a reliable clinical tool is needed to better identify peripheral TFCC lesions (Palmer 1B). This study introduces and validates the "TFCC Table Lift Test" (TTL test), a novel exam aimed at improving clinical detection of Palmer 1B TFCC injuries. The primary goal was to correlate TTL test scores with arthroscopic findings, using the Atzei classification to subcategorize lesions and assess the test's diagnostic utility.

We conducted a retrospective case-control study involving 314 patients with unilateral chronic ulnar-sided wrist pain who underwent wrist arthroscopy from January 2016 to December 2023. All patients performed the TTL test during preoperative assessment, which involved lifting a flat surface with fingertips while the wrist was in full supination and extension. Pain intensity was scored using a Visual Analogue Scale (VAS, 0-10) and compared to the unaffected side. Exclusion criteria included bilateral pain, previous wrist surgery, or other wrist disorders. Arthroscopy confirmed or excluded Palmer 1B TFCC lesions and subclassified them using the Atzei system. TTL scores were statistically analyzed for diagnostic correlation.

Of 314 patients, 213 (Group 1) were arthroscopically diagnosed with Palmer 1B TFCC lesions: 136 were Atzei Class 1, 75 Class 2, and 2 Class 3. The remaining 101 patients (Group 2) had other wrist conditions. All Group 1 patients had TTL scores >5, with severity reflected in increasing mean scores (Class 1: 6.52; Class 2: 8.15; Class 3: 9.0). All but three patients in Group 2 had scores <3. The TTL test showed 100 % sensitivity, 97.03 % specificity, 98.6 % positive predictive value, and 100 % negative predictive value. ROC analysis yielded an AUC of 0.999; the optimal threshold was VAS >5.

The TTL test is a simple, reproducible, and accurate clinical tool for detecting Palmer 1B TFCC lesions. A TTL score >5 strongly correlates with arthroscopic findings and reflects lesion severity, making it a valuable adjunct in the evaluation of ulnar-sided wrist pain.