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J Wrist Surg 2024; 13(02): 137-141
DOI: 10.1055/s-0043-1769791
Scientific Article

The “Bubble Test” in the Arthroscopic Diagnosis of Triangular Fibrocartilage Central Lesion: Description and Relevance to Treatment

Ricardo Kaempf de Oliveira 
1   Department of Hand Surgery, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
2   Department of Hand Surgeon, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
,
João Pedro Farina Brunelli 
1   Department of Hand Surgery, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
2   Department of Hand Surgeon, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
,
Márcio Aita 
3   Department of Hand Surgery, Faculdade de Medicina do ABC, Santo André, Brazil
,
Ezequiel Zaidenberg 
4   Department of Anatomy, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
,
Pedro J. Delgado 
5   Department of Hand Surgery, Hospital Universitário Madrid Montepríncipe, Universidad CEU San Pablo, Boadilla del Monte, Madrid, Spain
› Author Affiliations Funding None declared.
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Abstract

Background Ulnarly sided wrist pain is a common and challenging symptom. Arthroscopy has become a safe and effective tool for the correct diagnosis and treatment, proving to be better than all other clinical and imaging diagnostic methods. Some tests have been described for the diagnosis of triangular fibrocartilage (TFC) lesions, such as the trampoline test for peripheral lesions and the hook, ghost, and suction tests for foveal detachments. In tears at the disc level, when they affect all layers of the TFC (complete lesion) at the same point, testing with the probe will usually suffice for the diagnosis. However, in some apparently partial lesions, the probe cannot pass through all layers because the proximal and distal sites of the lesion are not aligned. There has been no arthroscopic test described for such cases.

Case Description We describe a simple and practical test that we have called the “bubble test” in a typical case to diagnose TFC central injuries, aiming to discriminate partial from complete lesions, which are eventually hard to differentiate through direct vision and arthroscopic probing, leading to a direct influence onto the treatment. The bubble test is performed with external compression of the distal radioulnar joint (DRUJ) aspect, with the thumb on the back of the DRUJ and the index and middle fingers onto the volar aspect. The abrupt compression of this region causes the passage of air mixed with synovial fluid from the DRUJ to the radiocarpal joint, generating bubble formation.

Clinical Relevance The bubble test should correlate to physical examination and imaging (magnetic resonance imaging [MRI]) findings and is particularly useful in central and degenerative (Type II) TFC lesions in patients complaining of chronic pain on the ulnar region of the wrist, with no history of trauma and with inconclusive MRI findings. Once the diagnosis is confirmed, arthroscopic treatment consists of wide debridement of the lesion with resection of the injured tissue and the local inflammatory reaction. Thus, it is essential for the correct treatment to define the exact location of the lesion and to know whether the disc injury is complete.

Keywords

triangular fibrocartilage complex - distal radioulnar joint wrist arthroscopy - articular disc - wrist extension


Publication History

Received: 10 November 2022

Accepted: 09 May 2023

Article published online:
12 June 2023

© 2023. Thieme. All rights reserved.

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