Dados do Trabalho

Título

THE “BUBBLES TEST” IN THE ARTHROSCOPIC DIAGNOSIS OF TRIANGULAR FIBROCARTILAGE CENTRAL LESION: DESCRIPTION AND RELEVANCE TO TREATMENT

Introdução e Objetivo

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. However, for central lesions there has been no arthroscopic test described, and the diagnosis must be made upon direct observation and palpation.

Material e Método

We describe a simple and practical test that we have called the “bubble test” 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 DRUJ (distal radioulnar joint) 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 RCJ (radiocarpal joint), generating bubble formation.

Resultados

The bubble test should correlate to physical examination and 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.

Discussão

The bubble test must be correlated with physical examination and imaging exam (MRI) findings. As such, the test is particularly useful in TFC central and degenerative (type II) lesions in patients complaining of wrist chronic, ulnar-sided pain, no history of trauma, and MRI that shows a partial lesion, as these cases are virtually impossible to define whether the lesion is complete or not without arthroscop

Conclusão

y. Since arthroscopic treatment comprises extensive lesion debridement, with resection of injured tissue and the local inflammatory reaction, it is essential to define the exact lesion location and whether it is complete or not.