Accuracy of the Pisiform Boost Test for the Diagnosis of Triangular Fibrocartilage Complex Tears in the Wrist - Pisiform Boost Test

Document Type : RESEARCH PAPER

Authors

Department of Plastic and Reconstructive Surgery, Ninewells Hospital, NHS Tayside, Dundee, Scotland

Abstract

Background: A retrospective study was conducted to evaluate the diagnostic accuracy of a novel examination 
technique, the ‘Pisiform Boost Test,’ in diagnosing a triangular fibrocartilage complex (TFCC) tear. 
Methods: Wrist arthroscopies performed between 2011-2021 were retrospectively reviewed. Patients’ clinical 
records were evaluated to determine the result of the Pisiform Boost Test during clinical examination and TFCC tear 
within the body of the TFCC as seen at wrist arthroscopy. The Pisiform Boost Test is performed by first assessing 
for ulna fovea pain on passive ulna deviation of the wrist and then assessing pain while the clinician applies digital 
pressure over the pisiform and passive ulna deviation. 
Results: The pisiform Boost test was found to have a Sensitivity of 91% (95% CI, 81 – 97%) and a Specificity of 33% 
(95% CI, 14-59%) for the diagnosis of TFCC tears. Positive predictive value of 83%, a negative predictive value of 
50%, and an accuracy of 78%. A chi-square test of independence was performed to examine the relation between a 
Positive Pisiform Boost Test and an arthroscopy-confirmed TFCC tear. The relation between these two variables was 
statistically significant, x2 (1, N = 82) = 6.4551, P=.011064. 
Conclusion: The Pisiform Boost Test demonstrates high sensitivity for TFCC tears (0.91). Specificity (0.33) is 
similar to that in the ulnar grinding test. Therefore, we propose this test be utilized with additional special tests for 
ulna-side wrist pain to allow clinicians to build a diagnostic picture, aiding decision-making and patient information.
Level of evidence: IV

Keywords

Main Subjects

References

1. Kaplan E. Functional and Surgical Anatomy of the 
Hand. 2nd ed. JB Lippincott Company; 1965.
2. Palmer A, Werner F. The triangular fibrocartilage 
complex of the wrist—anatomy and function. Journal 
of Hand Surgery. 1981;14(4):594-606. doi:10.1016/
S0363-5023(81)80170-0
3. Sachar K. Ulnar-sided Wrist Pain: Evaluation and 
Treatment of Triangular Fibrocartilage Complex 
Tears, Ulnocarpal Impaction Syndrome, and Lunotriquetral Ligament Tears. J Hand Surg Am. 2012;37(7). 
doi:10.1016/j.jhsa.2012.04.036
4. Vezeridis P, Yoshioka H, Han R, Blazar P. Ulnar-sided 
wrist pain. Part I: anatomy and physical examination. 
Skeletal Radiology . 2010;39:733-745. doi:10.1007/
s00256-009-0775-x
5. Liao JCY, Chong AKS, Tan DMK. Causes and assessment  of subacute and chronic rist pain. Singapore Med J. 
2013;54(10):592-598. doi:10.11622/smedj.2013205
6. Shin AY, Deitch MA, Sachar K, Boyer MI. Ulnar-sided 
wrist pain: Diagnosis and treatment. J Bone Joint Surg. 
2004;86(7):1560-1574. https://digitalcommons.
wustl.edu/open_access_pubs/1104
7. Taleisnik J. Pain on the ulnar side of the wrist. Hand 
Clin. 1987;3(1):51-68. doi:doi.org/10.1016/S0749-
0712(21)00635-1.
8. Howse C. Wrist Injuries in Sport. Sports Medicine. 
1994;17(3). doi:10.2165/00007256-199417030-00003
9. Watanabe A, Souza F, Vezeridis P, Blazar P, Yoshioka 
H. Ulnar-sided wrist pain. II. Clinical imaging and 
treatment. Skeletal Radiol. 2010;39(9):837-857. 
doi:10.1007/s00256-009-0842-3
10.Kleinman W. Stability of the distal radioulna joint: 
biomechanics, pathophysiology, physical diagnosis, 
and restoration of function what we have learned in 
25 years. Journal of Hand Surgery . 2007;32(7):1086-
1106. doi:10.1016/j.jhsa.2007.06.014
11.Palmer A, Werner F. Biomechanics of the distal 
radioulnar joint. Clin Orthop Relat Res. 1984;186:26-
35. doi:10.1097/00003086-198407000-00005
12.Palmer AK. Triangular fibrocartilage complex lesions: 
A classification. J Hand Surg Am. 1989;14(4):594-606. 
doi:10.1016/0363-5023(89)90174-3
13.Andersson J, Andernord D, Karlsson J, Fridén J. 
Efficacy of magnetic resonance imaging and clinical 
tests in diagnostics of wrist ligament injuries: a 
systematic review. Arthroscopy. 2015;31:2014-2020. 
doi:10.1016/j.arthro.2015.04.090
14.Cherian BS, Bhat AK, Rajagopal KV, Maddukuri SB, 
Paul D, Mathai NJ. Comparison of MRI & direct 
MR arthrography with arthroscopy in diagnosing 
ligament injuries of wrist. J Orthop. 2020;19. 
doi:10.1016/j.jor.2019.11.014
15.Petsatodis E, Pilavaki M, Kalogera A, Drevelegas A, 
Agathangelidis F, Ditsios K. Comparison between 
conventional MRI and MR arthrography in the 
diagnosis of triangular fibrocartilage tears and 
correlation with arthroscopic findings. Injury. 
2019;50(8). doi:10.1016/j.injury.2019.07.032
16.Crosby N, Greenberg J. Ulnar-Sided Wrist Pain in 
the Athlete. Clin Sports Med. 2015;34(1):127-141. 
doi:10.1016/j.csm.2014.09.008
17.Hal M van. Ulnar Sided Wrist Pain; Consider 
Pisotriquetral (PT) Pathology. Orthopedics and 
Rheumatology Open Access Journal. 2017;9(4). 
doi:10.19080/OROAJ.2017.09.555768
18.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(6). doi:10.1007/
s00402-016-2441-9
19.Tay SC, Tomita K, Berger RA. The “Ulnar Fovea Sign” for 
Defining Ulnar Wrist Pain: An Analysis of Sensitivity 
and Specificity. J Hand Surg Am. 2007;32(4). 
doi:10.1016/j.jhsa.2007.01.022
20. Lester B, Halbrecht J, Levy IM, Gaudinez R. “Press 
Test” for Office Diagnosis of Triangular Fibrocartilage 
Complex Tears of the Wrist. Ann Plast Surg. 1995;35(1). 
doi:10.1097/00000637-199507000-00009
21.Brennan C, Yong L, Foley J, McKie S, Rust P. The Value 
of the Distal Radioulnar Joint Effusion in Diagnosing 
Triangular Fibrocartilage Complex Tears on Magnetic 
Resonance Imaging. Arch Bone Jt Surg. 2021;9(4):423-
426.
22.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(4). doi:10.1016/S1836-9553(11)70055-8
23.Nakamura R, Horii E, Imaeda T, Nakao E, Kato H, 
Watanabe K. The Ulnocarpal Stress Test in the 
Diagnosis of Ulnar-Sided Wrist Pain. Journal of 
Hand Surgery. 1997;22(6). doi:10.1016/S0266-
7681(97)80432-9
24.Hertling D, Kessler R. Management of Common 
Musculoskeletal Disorders: Physical Therapy Principles 
and Methods. Lippincott; 1990.
The Archives of Bone and Joint Surgery
Volume 11, Issue 2
February 2023
Pages 124-129

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History

  • Receive Date: 19 August 2022
  • Revise Date: 20 October 2022
  • Accept Date: 22 October 2022

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