Diagnosis: Positive foveal sign (point tenderness over the ulnar aspect of the wrist where the TFCC inserts into the ulna), reproducible discomfort with stress to the dorsal or palmar radioulnar ligaments.

Imaging: MRI, MR arthrography, arthroscopy, and arthrogram (not routinely done with improved qualities of MR).

Treatment

Diagnosis: Instability of the DRUJ in supination, neutral, or pronation.

Imaging: Plain x-ray; CT scan in neutral, pronation, and supination; MRI to evaluate the TFCC.

Treatment: Acute instability may be amenable to TFCC repair. Chronic instability will require reconstruction.

Diagnosis: Pain with ulnar deviation or ulnar-sided loading, radiographic changes in ulnar head or lunate/triquetrum, associated with ulnar positive variance.

Imaging: Zero rotation plain x-rays and MRI with changes in the proximal ulnar corner of the lunate (to differentiate from Keinbocks, when the entire lunate is involved). Dynamic ulnocarpal impaction may be seen and is best imaged with a pronated grip view radiograph.

Treatment: Ulnar shortening (wafer vs. osteotomy).

Diagnosis: Pain over the ECU tendon, pain with resisted wrist extension and ulnar deviation over the ECU, painful snapping (instability) of the ECU with supination/pronation.

Treatment: Bracing, activity modification, anti-inflammatories, injection, ECU debridement, sixth compartment retinacular reconstruction.

Diagnosis: Pain over the FCU tendon, pain with resisted wrist flexion over the FCU tendon.

Treatment: Bracing, anti-inflammatories, injection, and surgical debridement

Diagnosis: Positive pisotriquetral grind sign

Imaging: Carpal tunnel view x-ray or 30 degree supinated view of wrist demonstrates pisotriquetral arthritic changes

Treatment: Bracing, anti-inflammatories, steroid injection, and pisiform excision

Diagnosis: Lunotriquetral shuck, pain over lunotriquetral ligament, may be associated with ulnar carpal impaction in chronic cases.

Imaging: MRI or MR arthrography—often difficult to diagnosis without arthroscopy.

Treatment: bracing, anti-inflammatories, injection, arthroscopic debridement, pinning, ligament reconstruction, lunotriquetral fusion, 4 corner fusion.

Diagnosis: Pain to palpation of the hamate and history of trauma

Imaging: Carpal tunnel view x-ray and CT scan

Treatment: Immobilization, open reduction internal fixation, and excision

Diagnosis: History of repeated trauma to the hypothenar base, pain and numbness of ulnar-sided digits, cold intolerance, and ulcerations

Imaging: Angiogram, MR angiogram, or CT angiogram

Treatment: Activity modification, bracing, smoking cessation, anti-inflammatories, calcium channel blockers, thrombolytics, and surgical reconstruction

Diagnosis: Pain and swelling over first CMC joint, positive CMC grind sign

Imaging: x-ray with arthritic changes the trapezium, can involve only the thumb CMC joint alone, or with the STT joint

Treatment: Bracing, anti-inflammatories, injection of steroids, hyaluronate injection, joint debridement (open or arthroscopic), first metacarpal osteotomy, trapeiometacarpal fusion, trapeziectomy ± ligament reconstruction ± tendon interposition, and implant arthroplasty

Diagnosis: Swelling over the dorsoradial aspect of the wrist, loss of wrist flexion/extension, pain to palpation over the STT joint

Imaging: x-ray with arthritic changes of STT joint

Treatment: Bracing, activity modification, anti-inflammatories, injection, STT fusion, trapezium excision with or without ligament reconstruction, and interposition