The TFCC Compression Test is a wrist special test used to provoke ulnar-sided wrist symptoms by applying axial compression through the wrist, usually with ulnar deviation and forearm rotation. It is commonly used when triangular fibrocartilage complex involvement, distal radioulnar joint symptoms or ulnar-sided wrist pain are part of the assessment reasoning.
A positive finding may include familiar ulnar-sided wrist pain, clicking, catching, weakness, apprehension or symptom reproduction during compression and rotation. However, the test does not confirm TFCC injury on its own. It should be interpreted alongside history, mechanism, fovea sign, DRUJ stability assessment, wrist range of motion, grip strength, imaging where relevant and other ulnar-sided wrist tests.
The triangular fibrocartilage complex, commonly called the TFCC, is an important soft tissue structure on the ulnar side of the wrist. It contributes to load transmission, distal radioulnar joint stability and ulnar-sided wrist function. TFCC-related symptoms may occur after trauma, repetitive loading, rotational strain, gripping, weight-bearing through the hand or degenerative change.
The TFCC Compression Test is designed to reproduce ulnar-sided wrist symptoms by loading the wrist in a compressed and often ulnar-deviated position. Some variations also include forearm pronation and supination to stress the ulnar wrist and distal radioulnar joint.
The test may be useful when the client reports pain during gripping, twisting, pushing up from a chair, weight-bearing through the wrist, racquet sports, gymnastics, lifting or forearm rotation tasks.
However, ulnar-sided wrist pain has many possible contributors. A positive TFCC Compression Test does not confirm a TFCC tear. Symptoms may also arise from ulnocarpal impaction, distal radioulnar joint instability, extensor carpi ulnaris tendon involvement, lunotriquetral injury, pisotriquetral irritation, ulnar styloid issues or other wrist conditions.
For Measurz, the key is to record exact position, force, symptom location, clicking, rotation direction, pain score, comparison side and related findings.
Test name: TFCC Compression Test
Region: Wrist / ulnar-sided wrist
Primary purpose: Provoke ulnar-sided wrist symptoms with compression and rotation/deviation
Commonly associated presentation: TFCC-related wrist pain, ulnar-sided wrist pain, DRUJ symptoms
Positive finding: Familiar ulnar-sided wrist pain, clicking, catching or symptom reproduction during compression
Negative finding: No familiar ulnar-sided wrist symptoms during compression and movement
Main limitation: Ulnar-sided wrist pain is complex, and the test does not confirm TFCC injury on its own.
The TFCC Compression Test is a wrist provocation test.
The professional applies axial compression through the wrist, often while placing the wrist into ulnar deviation and moving the forearm through rotation. The goal is to load the ulnar side of the wrist and reproduce symptoms associated with TFCC or ulnar wrist involvement.
The test may be used to observe:
Ulnar-sided wrist pain
Clicking or catching
Pain with forearm rotation
Pain with ulnar deviation
DRUJ-region symptoms
Apprehension
Side-to-side difference
Symptom reproduction during loaded wrist movement
The TFCC Compression Test may be used to support assessment reasoning around:
Ulnar-sided wrist pain
TFCC-related symptoms
Distal radioulnar joint symptoms
Pain with gripping and twisting
Pain with weight-bearing through the wrist
Pain after fall or rotational wrist trauma
Clicking or catching on the ulnar side of the wrist
Sport or work tasks involving wrist load
Baseline and retest documentation in Measurz
It is most useful when symptoms reproduced by the test match the client’s familiar wrist complaint.
The TFCC Compression Test assesses symptom response to ulnar-sided wrist compression and movement.
It may provide information about:
Ulnar wrist symptom provocation
Compression sensitivity
Rotation sensitivity
Ulnar deviation sensitivity
Clicking or catching
DRUJ-region irritability
Side-to-side difference
Load-related wrist tolerance
It does not directly assess:
TFCC tear with certainty
Tear type or location
DRUJ instability with certainty
Ulnocarpal impaction with certainty
Imaging findings
Ligament integrity with certainty
ECU tendon pathology
Grip strength
Return-to-sport readiness
Return-to-work readiness
Treatment need
The TFCC Compression Test may be useful for clients with:
Ulnar-sided wrist pain
Pain with gripping and twisting
Pain with forearm pronation or supination
Pain with push-up or weight-bearing wrist positions
Clicking or catching at the ulnar wrist
Wrist symptoms after trauma
Racquet, gymnastics, combat sport or lifting-related wrist symptoms
Distal radioulnar joint symptom reports
A need for baseline and retest documentation in Measurz
It may also be useful for professionals learning how ulnar wrist symptom location guides further testing.
Consider using the TFCC Compression Test when:
Ulnar-sided wrist pain is the main complaint
TFCC involvement is part of the assessment reasoning
Pain occurs with gripping, rotation or weight-bearing
Clicking or catching is reported
DRUJ symptoms are suspected
You want to compare compression response side to side
You are building a broader wrist assessment profile
It should be combined with history, fovea sign, DRUJ assessment, wrist range of motion, grip strength and other ulnar wrist tests.
Use caution or avoid the test when:
Recent fracture, dislocation or major trauma is suspected
Severe acute wrist pain is present
The wrist is highly irritable
The client cannot tolerate compression
Neurological symptoms require further assessment
Recent surgery makes compression inappropriate
There is marked swelling or deformity
The professional cannot control the wrist safely
Stop the test if pain increases sharply, clicking or catching feels unsafe, neurological symptoms occur, the client feels unstable, or the client asks to stop.
The TFCC Compression Test usually requires no equipment.
Optional equipment includes:
Measurz app
Pain rating scale
Wrist range of motion record
Grip strength tool
Pinch strength tool
Notes field for compression, rotation direction and symptoms
Imaging or referral notes if relevant
Video recording for movement education where appropriate
Ask the client to sit with the forearm supported.
Explain the test:
“I am going to gently compress and move your wrist to see whether it reproduces your familiar ulnar-sided wrist symptoms. Tell me where you feel pain and whether you notice clicking or catching.”
Test the less symptomatic side first where appropriate.
The client sits with:
Shoulder relaxed
Elbow flexed comfortably
Forearm supported
Wrist accessible
Hand relaxed
Wrist positioned so the professional can apply compression and movement
The professional sits or stands facing the client’s hand and wrist.
The professional should control the forearm and hand while applying gentle compression.
One hand stabilises the distal forearm.
The other hand holds the hand or carpal region to apply axial compression through the wrist.
Avoid painful gripping.
Stabilise the forearm to reduce excessive elbow or shoulder movement.
The movement should occur at the wrist and forearm, not through the whole arm.
A common method is:
Place the wrist into slight ulnar deviation.
Apply gentle axial compression through the wrist.
Move the forearm/wrist through pronation and supination or rotate the wrist under compression.
Observe for ulnar-sided pain, clicking or familiar symptoms.
The force should be controlled and symptom-limited.
Tell the client:
“Tell me if this reproduces your familiar ulnar wrist pain, clicking, catching or weakness. Point to the exact location.”
A positive finding may include:
Familiar ulnar-sided wrist pain
Pain near the TFCC/fovea region
Clicking or catching with familiar pain
Pain during compression and rotation
Pain during ulnar deviation loading
Apprehension or instability sensation
Clear side-to-side difference
Symptoms matching the client’s functional complaint
Record whether pain, clicking, catching or instability was the main finding.
A negative finding may include:
No familiar ulnar-sided wrist pain
No clicking or catching
No relevant side-to-side difference
No symptom reproduction during compression
Only mild non-familiar pressure discomfort
A negative finding does not fully exclude TFCC involvement.
Stop the test if:
Pain increases sharply
Clicking or catching feels unsafe
Neurological symptoms occur
The wrist feels unstable
The client asks to stop
The test is too irritable to interpret
Use gentle compression and controlled movement. Avoid aggressive twisting or loading, especially after acute trauma.
A positive TFCC Compression Test may increase suspicion that ulnar-sided wrist loading is relevant to the client’s symptoms. It is more meaningful when it reproduces the client’s familiar pain at the ulnar wrist, especially with clicking, catching or pain during gripping/rotation tasks.
However, a positive test does not confirm TFCC injury. Ulnar-sided wrist pain can arise from multiple structures, including the TFCC, distal radioulnar joint, ulnocarpal joint, lunotriquetral ligament, extensor carpi ulnaris tendon, pisotriquetral joint and other local structures.
A negative TFCC Compression Test may reduce suspicion that this specific compression/rotation position reproduces symptoms in that session. However, it does not exclude TFCC involvement, especially if symptoms occur only under higher load, weight-bearing, sport-specific tasks or fatigue.
The result is more meaningful when interpreted with:
Mechanism of injury
Ulnar-sided pain location
Fovea sign
DRUJ stability assessment
Wrist range of motion
Grip strength
Pinch strength
TFCC load tests
ECU assessment
Scapholunate and lunotriquetral assessment
Imaging where relevant
Diagnostic accuracy evidence for TFCC provocation tests is limited and varies across test types, populations and reference standards.
A review of TFCC provocation tests concluded that despite frequent clinical use, the current evidence on diagnostic accuracy and reliability of these tests is limited. This means the TFCC Compression Test should not be used as a stand-alone diagnostic test.
Related evidence for ulnar-sided wrist tests includes:
Condition or presentation: TFCC injury / ulnar-sided wrist pain
Population: Wrist pain or suspected TFCC populations depending on study
Test variation: TFCC compression/load tests, fovea sign and related provocation tests
Reference standard: Arthroscopy, imaging, diagnostic injection or clinical reference standards depending on study
Sensitivity: Variable; related fovea sign evidence has reported values such as 89% sensitivity for TFCC injuries in one study summary
Specificity: Variable; related fovea sign evidence has reported values such as 48% specificity for TFCC injuries in one study summary
Positive likelihood ratio: Variable and often limited by low specificity
Negative likelihood ratio: Variable and test-dependent
Key limitations: Test heterogeneity, small samples, different lesion types, inconsistent reference standards and overlap with other ulnar-sided wrist conditions.
Plain-language interpretation:
A positive TFCC Compression Test may support suspicion when symptoms are local and familiar.
A positive test does not confirm a TFCC tear.
A negative test does not exclude TFCC involvement.
TFCC-related reasoning is stronger when multiple findings point in the same direction.
Fovea sign, DRUJ assessment, mechanism and imaging/referral context may help interpretation.
Reliability evidence for the exact TFCC Compression Test appears limited.
Reliability may be affected by:
Wrist position
Amount of compression
Degree of ulnar deviation
Rotation direction
Speed of movement
Client irritability
Definition of a positive test
Whether pain, clicking or apprehension is counted
Professional experience
Validity is limited as a stand-alone diagnostic test. The TFCC Compression Test has practical face validity because it loads the ulnar wrist, but it does not isolate the TFCC or distinguish between different ulnar-sided wrist structures.
Reliability improves when the professional records:
Wrist position
Compression force
Rotation direction
Symptom location
Pain score
Clicking/catching
Comparison side
Related fovea and DRUJ findings
Test confidence
Common errors include:
Applying too much compression
Twisting too aggressively
Not recording wrist position
Not recording exact symptom location
Treating any ulnar wrist pain as TFCC injury
Ignoring DRUJ instability
Ignoring ECU tendon symptoms
Not comparing sides
Not recording clicking or catching separately
Using the test as a stand-alone diagnosis
Limitations include:
Ulnar-sided wrist pain has many causes
Diagnostic accuracy evidence is limited
The test does not isolate the TFCC
Compression force is difficult to standardise
Clicking can occur without clear pathology
Symptoms may appear only under higher functional loads
A single test should not guide decisions alone
The TFCC Compression Test may be useful for:
Ulnar-sided wrist assessment
TFCC-related assessment reasoning
Recording compression/rotation symptom response
Comparing sides
Baseline and retest documentation
Guiding more specific wrist assessment
Client education around provocative wrist positions
Supporting Measurz wrist assessment reports
In Measurz, it can be recorded alongside fovea sign, DRUJ stability testing, wrist range of motion, grip strength, pinch strength, ECU tests, Scaphoid Compression Test, wrist weight-bearing tests and functional hand assessments.
Record:
Test name: TFCC Compression Test
Side tested
Wrist position
Forearm position
Compression used: light/moderate
Rotation direction
Ulnar deviation position
Result: positive, negative, unclear or unable to test
Pain score
Exact symptom location
Whether symptoms were familiar
Clicking or catching
Apprehension or instability sensation
Comparison side
Fovea sign result if tested
DRUJ findings if tested
Grip or pinch findings
Irritability
Reason for stopping if relevant
Related wrist findings
Confidence in interpretation
Further assessment/referral notes if appropriate
Retest date if relevant
Recording these details improves repeatability, communication, client education, assessment reasoning, monitoring over time, team consistency and reporting quality.
Fovea Sign
DRUJ Ballottement Test
Ulnocarpal Stress Test
Press Test
Piano Key Sign
ECU Synergy Test
Wrist Range of Motion
Grip Strength
Pinch Strength
Scaphoid Compression Test
Scapholunate Tests
Wringing Test
It assesses whether ulnar-sided wrist compression and movement reproduce symptoms that may be associated with TFCC or ulnar wrist involvement.
A positive finding may include familiar ulnar-sided wrist pain, clicking, catching or symptom reproduction during compression and rotation.
No. It may increase suspicion, but it does not confirm a TFCC tear on its own.
No. A negative test does not fully exclude TFCC involvement, especially if symptoms occur only under higher load or specific tasks.
Many structures can cause ulnar-sided wrist pain, including TFCC, DRUJ, ECU tendon, lunotriquetral ligament and ulnocarpal joint structures.
Yes. Record whether clicking is painful, familiar and associated with the client’s usual symptoms.
Yes, side-to-side comparison improves interpretation when safe and appropriate.
History, fovea sign, DRUJ assessment, wrist range of motion, grip strength, ECU testing, ulnocarpal tests and imaging/referral context where relevant.
The TFCC Compression Test loads the ulnar side of the wrist with compression and movement.
A positive result may support TFCC-related assessment reasoning when symptoms are familiar and local.
The test does not confirm a TFCC tear on its own.
A negative result does not exclude TFCC involvement.
Evidence for TFCC provocation test accuracy and reliability is limited.
Measurz recording should include wrist position, compression, rotation direction, pain location, clicking/catching, comparison side and related fovea/DRUJ findings.
Atzei, A., & Luchetti, R. (2011). Foveal TFCC tear classification and treatment. Hand Clinics, 27(3), 263–272. https://doi.org/10.1016/j.hcl.2011.05.014
Chan, J. J., Teunis, T., Ring, D., & Jupiter, J. B. (2014). The diagnostic performance characteristics of imaging modalities for triangular fibrocartilage complex injuries: A meta-analysis. Journal of Hand Surgery, 39(8), 1483–1490. https://doi.org/10.1016/j.jhsa.2014.04.019
Lindau, T., Adlercreutz, C., Aspenberg, P., & Arner, M. (2000). Peripheral tears of the triangular fibrocartilage complex cause distal radioulnar joint instability after distal radial fractures. Journal of Hand Surgery, 25(5), 464–468.
Prosser, R., Harvey, L., LaStayo, P., Hargreaves, I., Scougall, P., & Herbert, R. D. (2011). Provocative wrist tests and MRI are of limited diagnostic value for suspected wrist ligament injuries: A cross-sectional study. Journal of Physiotherapy, 57(4), 247–253. https://doi.org/10.1016/S1836-9553(11)70055-2
Tay, S. C., Tomita, K., Berger, R. A. (2007). The “ulnar fovea sign” for defining ulnar wrist pain: An analysis of sensitivity and specificity. Journal of Hand Surgery, 32(4), 438–444. https://doi.org/10.1016/j.jhsa.2007.01.008
