This narrative review from Brown University presents a systematic, anatomy-driven approach to evaluating ulnar-sided wrist pain — one of the most diagnostically challenging regions in hand surgery. It walks through history-taking, directed palpation, five key provocative tests with reported performance metrics, and a sequenced imaging algorithm from plain films through MRI and arthroscopy.
When a patient presents with ulnar wrist pain, start with the ulnocarpal stress test to confirm the side, then sequence your provocative tests anatomically — ulnar fovea sign for TFCC/DRUJ, shuck/shear tests for LT ligament, ECU synergy for tendinopathy.
Don't anchor on MRI alone: a third of asymptomatic wrists have TFCC signal changes, so a positive MRI without a matching exam finding is not a diagnosis.
This narrative review from Brown University presents a systematic, anatomy-driven approach to evaluating ulnar-sided wrist pain — one of the most diagnostically challenging regions in hand surgery. It walks through history-taking, directed palpation, five key provocative tests with reported performance metrics, and a sequenced imaging algorithm from plain films through MRI and arthroscopy.
When a patient presents with ulnar wrist pain, start with the ulnocarpal stress test to confirm the side, then sequence your provocative tests anatomically — ulnar fovea sign for TFCC/DRUJ, shuck/shear tests for LT ligament, ECU synergy for tendinopathy.
Don't anchor on MRI alone: a third of asymptomatic wrists have TFCC signal changes, so a positive MRI without a matching exam finding is not a diagnosis.