Sharpey’s Test: A Key Clinical Examination for TFCC and Ulnocarpal Abutment

Published November 1, 2026 Read time 6 min read Readers 62
Sharpey’s Test

What Is Sharpey’s Test?

Sharpey’s Test is a provocative clinical examination maneuver used to assess the integrity of the triangular fibrocartilage complex (TFCC) and to evaluate for ulnocarpal abutment syndrome. It is a valuable tool for clinicians investigating ulnar-sided wrist pain, a common and often challenging diagnostic presentation. The test combines axial loading with wrist movement to stress the TFCC and the ulnocarpal joint, helping to reproduce symptoms associated with TFCC tears, degeneration, or abnormal contact between the distal ulna and the carpal bones.

The TFCC is a complex fibrocartilaginous and ligamentous structure located on the ulnar aspect of the wrist. It acts as a shock absorber and stabilizer between the distal ulna and the carpal bones (particularly the lunate and triquetrum). When the TFCC is injured or when there is positive ulnar variance (the ulna is longer than the radius), the resulting mechanical stress can lead to ulnocarpal abutment—a condition characterized by excessive contact and compression between the ulnar head and the ulnar carpus. Sharpey’s Test is designed to dynamically provoke this pathological stress and reproduce the patient’s symptoms.

How to Perform Sharpey’s Test

Proper technique is essential to obtain reliable results. The procedure is straightforward and can be performed in a standard clinical setting. The patient should be seated comfortably with the arm extended and the forearm in neutral rotation; supporting the elbow on the examination table enhances stability.

The examiner establishes control using both hands. One hand firmly grasps the patient’s distal forearm, stabilizing the radius and ulna, while the other hand securely holds the patient’s hand. The examiner then applies an axial load by compressing along the long axis of the forearm while simultaneously moving the wrist into ulnar deviation. During this loaded maneuver, the wrist is moved through dorsal and palmar flexion, and the forearm is rotated between pronation and supination. These movements are performed dynamically and can be combined in various sequences to effectively stress the TFCC and the ulnocarpal joint.

Some descriptions of the test emphasize stabilizing the distal radioulnar joint (DRUJ) and proximal carpal row, applying a compressive force of the carpus into the DRUJ, and then adding a rotational force in pronation and supination. Regardless of the specific variation, the core principle remains the same: axial loading combined with wrist motion to provoke ulnar-sided pathology.

What Does a Positive Sharpey’s Test Indicate?

A positive Sharpey’s Test is characterized by the reproduction of pain, clicking, or crepitus in the region of the TFCC or the ulnocarpal joint. The pain may be described as sharp, aching, or grinding, while clicking may be audible or palpable. Crepitus presents as a grating or grinding sensation that can be felt by both the examiner and the patient during the maneuver.

These findings suggest the presence of TFCC tears or degeneration and can assist in diagnosing ulnocarpal abutment syndrome. The test is useful for differentiating ulnar-sided wrist pain from other causes; however, it is not pathognomonic for any single condition. It should always be interpreted alongside other clinical findings, and it may produce false positives in patients with generalized joint hypermobility. Therefore, correlation with imaging studies—such as MRI arthrography, which is considered the gold standard for TFCC evaluation—is often necessary for a definitive diagnosis.

Clinical Context and Diagnostic Value

Sharpey’s Test is part of a comprehensive wrist examination. A thorough history should document the mechanism of injury, duration of symptoms, and aggravating factors. Physical inspection should look for swelling, deformity, or muscle atrophy, followed by systematic palpation with attention to point tenderness over the TFCC. Range of motion assessment and additional special tests (e.g., TFCC compression test, piano key sign) can provide complementary diagnostic information.

The ulnocarpal stress test, which shares biomechanical principles with Sharpey’s Test, has been studied for its diagnostic utility. In a landmark study by Nakamura et al., 45 patients with persistent ulnar-sided wrist pain and a positive ulnocarpal stress test underwent comprehensive evaluation. The final diagnosis was ulnocarpal abutment syndrome in 28 patients, traumatic TFCC tear in six, and other ulnar wrist pathologies in the remainder. The authors concluded that the ulnocarpal stress test is a useful provocative test and is sufficiently sensitive to warrant further investigation by arthroscopy. It is important to note, however, that positive ulnocarpal stress testing is sensitive for a variety of intra-articular ulnar wrist pathologies and is not specific for ulnocarpal abutment syndrome alone.

A more recent prospective study by Ou Yang et al. (2021) analyzed diagnostic clinical tests for ulnar-sided wrist pain. The ulnar foveal sign demonstrated a sensitivity of 89% and specificity of 48% for TFCC injuries, and 85% and 37% for ulnocarpal abutment syndrome, respectively. The authors noted that the ulnocarpal stress test and the ulnar foveal sign were not sufficiently specific on their own, highlighting the need for imaging or arthroscopic confirmation. These findings underscore that Sharpey’s Test, like other provocative maneuvers, is a valuable screening tool but should not be used in isolation.

Frequently Asked Questions (FAQ)

1. What is the primary purpose of Sharpey’s Test?
Sharpey’s Test is used to assess the integrity of the triangular fibrocartilage complex (TFCC) and to evaluate for ulnocarpal abutment syndrome by reproducing pain, clicking, or crepitus in the ulnar-sided wrist.

2. How is Sharpey’s Test performed?
The examiner stabilizes the patient’s forearm with one hand and holds the hand with the other. An axial load is applied while the wrist is moved into ulnar deviation and through dorsal-palmar flexion, often combined with forearm pronation and supination.

3. What constitutes a positive Sharpey’s Test?
A positive test is indicated by the reproduction of pain, clicking, or crepitus in the TFCC or ulnocarpal region during the maneuver.

4. Is Sharpey’s Test specific for TFCC tears?
No, the test is not pathognomonic for any single condition. It is sensitive for various intra-articular ulnar wrist pathologies, including TFCC tears and ulnocarpal abutment, but it is not highly specific. Findings must be correlated with imaging and other clinical signs.

5. What should be done if Sharpey’s Test is positive?
A positive result typically warrants further evaluation, often beginning with plain radiographs to assess ulnar variance, followed by MRI arthrography, which is the gold standard for TFCC evaluation. Diagnostic injection into the ulnocarpal joint may also provide diagnostic and therapeutic value.

References

  1. OrthoFixar. Sharpey’s Test: Evaluating TFCC Integrity. Available at: https://orthofixar.com/special-test/sharpeys-test-for-tfcc/
  2. Nakamura R, Horii E, Imaeda T, et al. The ulnocarpal stress test in the diagnosis of ulnar-sided wrist pain. J Hand Surg Br. 1997;22(6):719-723. PubMed PMID: 9457572. Available at: https://pubmed.ncbi.nlm.nih.gov/9457572/
  3. Ou Yang O, et al. Ulnar-sided wrist pain: a prospective analysis of diagnostic clinical tests. ANZ J Surg. 2021;91(10):2159-2162. doi:10.1111/ans.17169. PubMed PMID: 34459533. Available at: https://pubmed.ncbi.nlm.nih.gov/34459533/
  4. Ulnar Impaction Syndrome: A case series investigating the appropriate diagnosis, management, and post-operative considerations. PMC. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC4262812/