Ask a Doctor: Ulnar-Sided Wrist Pain

Hand surgeon Mark Yuhas, MD answers your questions about ulnar-sided wrist pain.

What does it mean to have “ulnar-sided” wrist pain?

Pain on the ulnar side of the wrist refers to pain in the region of the wrist on the “pinky side” of the wrist joint. The structures on the pinky side of the wrist make a complex interaction with bones, joints, ligaments, and tendons.  They allow us to grip, twist the forearm and wrist, and move the wrist forward (flexion) and backward (extension).  In the wrist, injury or wearing down of these structures may lead to pain or instability.

What are some causes of ulnar-sided wrist pain?

In a relatively small area on the ulnar side of the wrist, there are many different structures. The main structures that cause pain in this part of the wrist are ligaments (soft tissue that connects bone to bone), tendons (soft tissue that connects bone to muscle), bone, or cartilage (allow joints to move smoothly).  Also on this side of the wrist is the triangular fibrocartilage complex (TFCC) which is a group of soft tissue structures that work together.

An injury, such as a fall or twisting the wrist awkwardly, can lead to ulnar-sided wrist pain. This may involve a ligament injury in the area of the TFCC, a broken bone, or stretched or torn tendon.

In other cases, pain can be caused by chronic “wear and tear” such as arthritis (joint inflammation and cartilage thinning), tendonitis (inflammation of tendon), or when bones on this side of the wrist hit against each other (ulnocarpal abutment or ulnar impaction). Some people may have a mismatch in the lengths of their two forearm bones that could lead to some of these problems.

Finally, pain from a variety of less common factors must be considered. The ulnar nerve could be compressed or irritated. Additionally, pain could be caused by a mass such as a ganglion cyst or tumor.

What are some signs and symptoms of ulnar-sided wrist pain?

  • Patients may complain of an aching dull pain near the pinky side of the wrist or a sharp, short -lasting pain when moving the wrist in certain directions.
  • Swelling and bruising may be present after an injury, and numbness and tingling in the pinky and ring fingers may signal a nerve problem.
  • Patients may also describe a clicking or snapping sensation near this side of the wrist that may represent a ligament or tendon abnormality.
  • Finally, stiffness with wrist movement and weakness with grip and squeezing may be the primary symptoms.

Should I see a hand surgeon for my pain? What tests may be ordered?

If you have pain that affects your daily activities and use of the wrist, it is a good idea to have this evaluated by a hand surgeon. Even without a known injury to the wrist, you can have this ulnar sided wrist pain.

When you visit a hand surgeon, expect a detailed wrist examination with some gentle movements and pressure on this area of your wrist. A detailed history is also very important.

X-rays of the involved wrist are also very common for evaluation. In some cases, an advanced study such as an MRI, ultrasound, or CT scan may be ordered to evaluate the wrist in more detail.

How is ulnar-sided wrist pain treated?

The cause of the pain, or the diagnosis, generally determines the treatment for this problem. Fortunately, many causes of ulnar-sided wrist pain can be treated without surgery. This may include a discussion about modifying some lifting and gripping activities for a period of time. Sometimes, bracing or taping the wrist in a specific way can be beneficial as well.

Other treatments, such as visiting a hand therapist, prescribing an anti-inflammatory medication, or offering a corticosteroid injection into the wrist may be suggested by your doctor.

In some cases when non-surgical treatment does not provide relief or is not indicated, then surgical treatment may be suggested.  Surgery will depend on the diagnosis and may include fixing a broken bone or using a camera (arthroscope) to look inside the wrist and fix a ligament. Other types of surgery may be suggested as well. It is important to speak with your hand surgeon to understand what treatment options are available and why they are suggesting these options for you.

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Dr. Mark Yuhas is an Orthopaedic Surgeon who specializes in Hand, Wrist, and Elbow care. He practices with Wellington Orthopaedic and Sports Medicine/ Mercy Orthopaedics and Sports Medicine in Cincinnati, OH. His current interests include trauma of the hand, wrist, and elbow; sports injuries of the upper extremity; and arthritis throughout the hand and wrist.

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