The Supination Lift Test assesses whether a loaded wrist position reproduces familiar ulnar-sided wrist pain, commonly in suspected triangular fibrocartilage complex involvement. The client places the palm under a table or similar surface and attempts to lift upward, loading the wrist in supination and extension. Current TFCC literature highlights that TFCC injuries are challenging to diagnose because of their complex anatomy and the limitations of both clinical tests and imaging, so the Supination Lift Test should not be used alone.
A client reports ulnar-sided wrist pain when pushing up from a chair, lifting with the palm up, catching, gripping, using a racquet or loading the wrist in extension. They may describe clicking, weakness, instability or a deep ache near the distal ulna.
The Supination Lift Test can help assess whether a loaded supinated wrist position reproduces familiar symptoms. It should be interpreted with wrist history, trauma mechanism, TFCC palpation, distal radioulnar joint findings, grip strength, clicking and imaging or referral when indicated.
Test name: Supination Lift Test
Body region: Ulnar wrist, TFCC region, distal radioulnar joint region
Purpose: Assess ulnar-sided wrist pain response to loaded supination and wrist extension
Positive finding: Familiar ulnar-sided wrist pain, weakness, instability, clicking or inability to lift due to symptoms
Negative finding: No familiar ulnar-sided wrist symptoms during the lift
Best used with: TFCC compression, ulnar fovea sign, DRUJ assessment, grip strength, wrist ROM, trauma history and imaging/referral when indicated
Key limitation: It does not confirm a TFCC tear on its own
The Supination Lift Test is a clinical wrist loading test used in suspected TFCC-related ulnar wrist pain. The client places the palm against the underside of a table or similar surface and attempts to lift upward. This loads the wrist in a position that can stress the ulnar wrist and TFCC region.
The test is used when TFCC involvement, ulnar-sided wrist pain or distal radioulnar joint-related symptoms are part of the assessment reasoning.
It may be relevant after a fall, twisting injury, racquet sport, gymnastics, weight training, gripping tasks or repeated forearm rotation.
The test assesses symptom response to loaded supination and wrist extension. It does not directly visualise the TFCC and does not confirm whether the lesion is central, peripheral, degenerative or traumatic.
Ulnar wrist pain may also be influenced by ulnar impaction, ECU tendon symptoms, lunotriquetral injury, DRUJ instability, pisotriquetral pain, fracture, nerve sensitivity or general load intolerance.
This test may be useful for clients with ulnar-sided wrist pain, post-trauma wrist symptoms, clicking, pain with gripping, racquet sport symptoms, gymnastics loading, weightlifting discomfort or pain with forearm rotation.
Use when ulnar-sided wrist pain is present and light loaded wrist testing is safe.
Use caution with acute trauma, suspected fracture, severe swelling, marked pain, recent surgery, obvious instability, neurological symptoms or inability to safely apply force.
Stable table or bench
Pain and symptom scale
Measurz recording workflow
Optional grip dynamometer
Optional comparison-side notes
Position the client seated beside a stable table.
The elbow is flexed and the forearm is supinated. The palm of the tested hand is placed flat against the underside of the table.
Stand or sit beside the wrist to observe movement and symptoms.
Manual contact is usually not needed, but the professional may support the forearm if required.
Keep the elbow and shoulder relaxed. Avoid trunk compensation.
Ask the client to attempt to lift the table upward using the palm, without jerking or forcing the movement.
Ask the client to report ulnar wrist pain, clicking, weakness, instability, symptom location and whether symptoms are familiar.
A positive finding is reproduction of familiar ulnar-sided wrist pain, painful clicking, instability sensation or inability to lift because of symptoms.
A negative finding is no familiar ulnar-sided wrist symptoms during the lift.
Stop if pain increases sharply, clicking is painful, instability is felt, symptoms persist or the client cannot perform the task safely.
Use a gentle effort first. Do not use maximal force in highly irritable or acute presentations.
A positive Supination Lift Test may increase suspicion of TFCC-related ulnar wrist pain when it reproduces familiar symptoms and matches history, palpation and other ulnar wrist findings. It does not confirm a TFCC tear.
A positive result may also reflect ECU symptoms, DRUJ instability, ulnar impaction, lunotriquetral involvement, joint irritation or general load sensitivity.
A negative test suggests the selected loading position did not reproduce symptoms, but it does not exclude TFCC involvement, especially if symptoms occur only with higher load, sport-specific positions, fatigue or rotation.
At the time of writing, high-quality 2020+ peer-reviewed diagnostic accuracy values for the Supination Lift Test alone appear limited.
Condition or presentation: suspected TFCC-related ulnar-sided wrist pain
Population: clients with ulnar wrist pain or suspected TFCC involvement
Test variation: palm under table, lifting upward with the wrist supinated and extended
Reference standard: not consistently established for this test alone
Sensitivity: not available
Specificity: not available
Positive likelihood ratio: not available
Negative likelihood ratio: not available
Key limitations: limited validation, variable load, overlap with other ulnar wrist conditions and difficulty diagnosing TFCC lesions clinically
A 2021 imaging study noted that TFCC injuries frequently cause ulnar-sided wrist pain and can induce distal radioulnar joint instability, while also highlighting the diagnostic challenge created by the TFCC’s complex three-dimensional anatomy.
Reliability depends on consistent load, hand position, forearm position, wrist position, effort level, pain criteria and comparison side.
The test is best understood as a functional symptom provocation test rather than a validated stand-alone diagnostic test.
Common errors include asking for maximal effort too early, not recording the load or setup, treating any ulnar discomfort as a TFCC tear, ignoring trauma history and not screening for fracture or DRUJ instability.
Limitations include poor structural specificity, load variability, pain sensitivity and limited diagnostic accuracy evidence.
Use the Supination Lift Test to document whether loaded supination reproduces familiar ulnar wrist symptoms. It can help guide load modification, further wrist testing, referral reasoning and progress tracking.
Record test name, side tested, result, pain score, symptom location, symptom quality, forearm position, wrist position, load/effort level, clicking, instability, weakness, comparison side, irritability, confidence in result and reason for stopping.
Add related findings such as TFCC compression, ulnar fovea sign, DRUJ assessment, grip strength, wrist ROM, trauma mechanism and referral/imaging notes.
TFCC Compression Test
Ulnar Fovea Sign
Scaphoid Shift Test
Scapholunate Ligament Assessment
Wrist ROM Tests
Grip Strength Test
Allen Test
Upper Limb Tension Tests
It assesses whether loaded supination and wrist extension reproduce familiar ulnar-sided wrist symptoms.
A positive result is familiar ulnar wrist pain, painful clicking, instability or inability to lift due to symptoms.
No. It may support suspicion but does not confirm a TFCC tear on its own.
ECU symptoms, DRUJ instability, ulnar impaction, lunotriquetral pain and general wrist irritability may also provoke symptoms.
Record side, pain score, wrist and forearm position, effort level, clicking, instability and related TFCC findings.
The Supination Lift Test is a loaded ulnar wrist symptom test.
A positive result may support TFCC-related reasoning when symptoms are familiar.
It does not confirm a TFCC tear on its own.
Load and position should be standardised for repeat testing.
Measurz should capture symptoms, position, clicking, instability and comparison side.
Huflage, H., Luetkens, K. S., Kunz, A. S., Conrads, N., Jakubietz, R. G., Jakubietz, M. G., Pennig, L., Goertz, L., Bley, T. A., Schmitt, R., & Grunz, J. P. (2021). Improved diagnostic accuracy for ulnar-sided TFCC lesions with radial reformation of 3D sequences in wrist MR arthrography. European Radiology, 31, 8757–8766.
Yao, J. (2023). Evaluation of the triangular fibrocartilage complex. In Wrist and Elbow Arthroscopy.
