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14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Arthroscopic diagnosis of TFCC peripheral tears using “Trampoline Test” and “Hook test”

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  • presenting/speaker Andrea Atzei - Clinica Giovanni XXIII, Monastier di Treviso, Italy
  • Riccardo Luchetti - Rimini Hand Centre, Rimini, Italy

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1973

doi: 10.3205/19ifssh0951, urn:nbn:de:0183-19ifssh09519

Published: February 6, 2020

© 2020 Atzei et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: The Trampoline and Hook test are commonly used in the arthroscopic assessment of TFCC tears. This study aims to evaluated the reliability and the advantages of these tests to identify laceration of the distal or proximal component at the periphery of the TFCC

Methods: The study group included 135 patients (97 male, 38 female, mean age 43.5 yrs) into 2 groups. Group A: 80 patients with chronic ulnar sided wrist pain and positive "fovea sign". Group B (control group): 55 patients with other complaints. Clinical DRUJ instability was evaluated by the ballottement test. Radiocarpal and DRUJ were scoped using "Dry Technique" and TFCC was tested by the Trampoline and Hook test. Test specificity, sensibility and likelihood ratio were assessed. Statistical significance was evaluated with the Pearson chi-square and Fisher's exact test.

Patients diagnosed as having a laceration of the foveal insertions of the TFCC were treated with bone anchor refutation of the tear. Patients with distal tear an intact foveal insertions of the TFCC were repaired with a capsular suture

Results and Conclusions: Trampoline and Hook test showed an overall specificity of 67,27% and 96,36%. Test sensibility was 75% and 0% (p<.001) when TFCC foveal insertions were intact and 56% and 100% (p<.001) when they were lacerated, respectively. Trampoline test showed an overall positive likelihood ratio of 2.4. Hook test showed an overall positive likelihood ratio of 22.

All patients improved after the selected treatment was performed according the the arthroscopic findings.

Trampoline and Hook test are reliable to make a diagnosis of peripheral TFCC tear. The Hook test shows higher specificity and sensibility to recognize TFCC tears. Values of positive likelihood ratio suggest that the probability to detect any TFCC peripheral tears is higher for the Hook than for the Trampoline test, especially when the foveal insertion of the TFCC is lacerated. The positive Hook test circumvents the need of a confirmatory DRUJ arthroscopy in case of suspected foveal detachment of the TFCC.