Lester B, Halbrecht J, Levy I M, Gaudinez R
Department of Orthopaedic Surgery, Albert Einstein College of Medicine, Bronx, NY, USA.
Ann Plast Surg. 1995 Jul;35(1):41-5. doi: 10.1097/00000637-199507000-00009.
We present a simple provocative diagnostic office test for detection of triangular fibrocartilage complex tears of the wrist. Twenty-seven patients with a working diagnosis of a triangular fibrocartilage complex tear complained of wrist pain caused by forceful use; 18 had a history of trauma. A "press test" was performed in each, requiring the seated patient to push the body weight up off a chair using the affected wrist, creating an axial ulnar load. A positive test provoked focal ulnar wrist pain replicating the discomfort that had prompted the patient to seek medical attention. Thirteen patients improved with conservative treatment. Seventeen underwent magnetic resonance imaging (showing 13 tears and 4 normal results) and two patients had arthrograms (both had tears). Fourteen patients had wrist arthroscopy; all had triangular fibrocartilage complex tears, which were debrided, with postoperative clinical improvement. As verified by arthroscopy, the press test had 100% sensitivity in preoperative tear detection compared with 79% for magnetic resonance imaging. The press test is recommended as a useful, free, noninvasive clinical test for triangular fibrocartilage complex tears of the wrist.
我们介绍一种用于检测腕部三角纤维软骨复合体撕裂的简单激发性诊断门诊检查。27例初步诊断为三角纤维软骨复合体撕裂的患者因用力使用腕部而出现腕部疼痛；18例有外伤史。对每位患者进行“按压试验”，要求就座的患者用患侧腕部将身体重量从椅子上撑起，产生轴向尺骨负荷。阳性试验会引发局灶性尺侧腕部疼痛，重现促使患者就医的不适症状。13例患者经保守治疗后病情改善。17例接受了磁共振成像检查（显示13例撕裂和4例正常结果），2例患者进行了关节造影（均显示有撕裂）。14例患者接受了腕关节镜检查；所有患者均有三角纤维软骨复合体撕裂，均进行了清创，术后临床症状改善。经关节镜证实，按压试验在术前撕裂检测中的敏感性为100%，而磁共振成像的敏感性为79%。按压试验被推荐为一种用于腕部三角纤维软骨复合体撕裂的有用、免费且无创的临床检查。
