Fovea Sign Test

What is ulnar-sided wrist pain?

The ulnar side of the wrist is the area on the side of the pinky finger. When healthcare professionals speak of ulnar-sided wrist pain, they speak of pain in this area. This kind of pain is a sign of a potential problem or injury concerning specific bones, tendons, and ligaments in the ulnar side of the wrist.

Symptoms of ulnar-sided wrist pain

People who are dealing with ulnar-sided wrist pain will likely experience the following symptoms:

• Ulnar fovea tenderness
• They will experience difficulty moving their wrist
• If they do manage to move their wrist, there might be clicking sounds
• They will also experience difficulty rotating their forearm
• A pain that gradually becomes worse the more they move their wrist or try to grip something
• If they do manage to grip something, the grip becomes weak over time due to the loss of strength

Causes of ulnar wrist pain

Ulnar-side wrist pain can be caused by something as simple as overusing the wrist. Anyone who participates in activities or work that involves constant wrist movement is prone to developing ulnar-sided wrist pain. If the wrist is constantly used without rest, the wrist tissues can get inflamed.

Ligament injuries (especially injuries of distal radioulnar ligaments), an unstable distal radioulnar joint, fractures (stress or otherwise), and any physical trauma to the hand can also cause ulnar-sided wrist pain. Arthritis can also cause this pain because it stiffens the wrist and may even inflame it.

For healthcare professionals to determine the specific wrist problem causing ulnar-sided wrist pain, they must conduct a comprehensive wrist examination that involves provocation and imaging tests. One such test that they can resort to is the Fovea Sign Test.

What is the Fovea Sign Test?

The (Ulnar) Fovea Sign Test is a provocation test designed to determine the potential cause of ulnar-sided wrist pain. It focuses on assessing the fovea, the spot between the ulnar styloid process and the flexor carpi ulnaris tendon.

How is this test conducted?

This test is one of the easiest provocation tests a healthcare professional can conduct because it doesn't require anything special. To conduct this test, the professional must do the following:

• Prepare an examination table.
• Have the patient sit on one side of the table and place the arm with the affected wrist on it.
• Have them position their arm in a 90° to 110° flexion.
• While keeping their arm in flexion, have them keep their wrist in a neutral position.
• Once the patient's arm and wrist are in position, you must place your thumb on the palmar surface between the ulnar head and the pisiform.
• Once your thumb is in position, press deep into the soft space.
• While pressing this space, observe your patient's face to see if they're in pain, or have them tell you if they feel pain.

How are the results interpreted?

The positive ulnar fovea sign for defining ulnar wrist pain is the patient's pained expression when you deeply press the specific space you're supposed to press during this test or if they specifically tell you that they feel pain when you press that space. If they don't feel any pain, the test is negative.

Next steps

After conducting this test, the next step is to conduct other provocation tests to determine the possibility of other problems besides ulnar-sided wrist pain and for consistency. Other recommended tests include the TFCC Compression Test, the Piano Key Sign Test, and the Ulnar Grinding Test.

Based on the study "The Ulnar Fovea Sign for Defining Ulnar Wrist Pain: An Analysis of Sensitivity and Specificity" by Tay and colleagues (2007), the Fovea Sign test was able to lead to the diagnosis of foveal disruption in 90 patients who have undergone the test, and UT ligament injuries for 68 other patients.

Imaging tests should be the final tests. These should confirm patients' specific problems (e.g., ulnar-sided wrist conditions, UT ligament tears, ligament injuries, etc.).

How to use our Fovea Sign Test template

More often than not, provocation tests such as the Fovea Sign Test don't have results sheets where professionals can jot down the results, findings, or potential plans for their patients. We at Carepatron created a template allowing you to do all that!

Using our template is easy. You need to indicate the patient's name, when they were assessed via this test, their medical history, and the reason for their visit. After filling out these sections, the test instructions are there if you need to refresh your knowledge on conducting the test. Immediately after that, there are two checkboxes for you to indicate a positive or negative result. Tick the appropriate outcome for your patient using a pen or mouse click/screen tap.

Below the result options is a notes box to discuss your findings, other observations, the next steps of the patient's examination, and potential treatments (e.g., NSAIDs, physical therapy, wrist arthroscopy, etc.).

Benefits of conducting this test

It's an easy test to conduct

Provocation tests are usually easy to conduct, and the Fovea Sign Test is no different. The instructions are clear and simple enough that the test can be done in a minute. Test conductors can get results quickly and move on to other scheduled tests to determine the specific problem causing the ulnar-sided wrist pain.

It can be conducted as a monitoring test down the line

Suppose the patient has been officially diagnosed with a specific problem causing ulnar-sided wrist pain and is undergoing treatment. In that case, this test can be conducted again to check if the patient is still ulnar fovea tenderness positive and if the pain is still there. If there's less pain and it's been gradually going away (or if the pain is completely gone), then the treatment plan is working as intended. If the pain is still the same, adjusting the treatment plan might do the trick.

Reference

Tay, S. C., Tomita, K., & Berger, R. A. (2007). The “Ulnar Fovea Sign” for defining ulnar wrist pain: An analysis of sensitivity and specificity. The Journal of Hand Surgery, 32(4), 438–444. https://doi.org/10.1016/j.jhsa.2007.01.022