The “Ulnar Fovea Sign” for Defining Ulnar Wrist Pain: An Analysis of Sensitivity and Specificity

Shian Chao Tay, Kazunari Tomita and Richard A. Berger

The purpose of this study was to examine whether the ulnar fovea sign is a useful clinical maneuver to detect foveal disruptions and UT ligament tears. The clinical records of 272 consecutive patients with wrist arthroscopy performed by the senior author from 1998 through to 2005 were reviewed. The ulnar fovea sign test is executed by pressing the examiner’s thumb distally into the interval between the ulnar styloid process and flexor carpi ulnaris tendon, between the volar surface of the ulnar head and the pisiform. A positive ulnar fovea sign is designated when there is exquisite tenderness that the patient claims replicates their pain, with comparisons made with the contralateral side.  The results showed  a total of 90 foveal disruptions and 68 UT ligament injuries diagnosed during wrist arthroscopy. The ulnar fovea sign was positive in 156 patients. The sensitivity of the fovea sign in detecting foveal disruptions and/or UT ligament injuries was 95.2% and its specificity was 86.5%. The authors conclude that the ulnar fovea sign is a useful clinical maneuver to detect foveal disruptions and UT ligament tears. The differentiation between the 2 conditions may be made clinically, where UT ligament tears are typically associated with a stable distal radioulnar joint and foveal disruptions are typically associated with an unstable distal radioulnar joint.

The Journal of Hand Surgery, Volume 32, Issue 4, April 2007, Pages 438-444

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