You suddenly move your wrist in a twisting motion as you have done many times over many years…. thinking nothing of it…. You then feel a sharp pain. Oh no….. what now? I hate going to the Doctor….
Let us save you the journey and making the effort an appointment with your G.P even if you could get through and make one. The NHS isn’t what it used to be. So we are here to help you and give you FAST acting remedies here at the Joint Pain Clinic.
Here are some things to consider when you have this kind of pain.
The most common cause of wrist pain is trauma in active people and athletes and when making repetitive movements when you are struggling in the office working at a job or in more sedentary individuals. However, many long-term conditions may also cause wrist pain. However, if we want to determine the origin of this type of pain, it is essential to locate the source and examine the structures in the affected region.
Another important aspect is whether the pain is acute or chronic. Acute pain has a sudden and unexpected onset and usually results from injuries and trauma, while chronic pain points out at inflammatory or degenerative conditions that develop in the long term.
In this article, we will examine the causes of wrist pain located on the ulnar side of the wrist, also known as the pinky side.
Structures in the ulnar side of the wrist
The ulnar aspect of the wrist joins the distal part of the ulna with a shock-absorbing structure called “triangular fibrocartilage complex”. This structure is fundamental in stabilising the wrist; it looks like a triangle with no bone in the radiographs because it is formed by a series of ligaments, tendons, and a fibrocartilaginous structure called ulnomeniscal homologue. All of them join together to form a complex that works similar to the meniscus in the knee.
The triangular fibrocartilage complex is attached to a depression in the bone that is next to the styloid process. This area has one ligament that runs along the carpal rows of bones (lunotriquetral ligament) and the tendon of the extensor carpi ulnaris, the muscle that extends the pinky finger.
What causes ulnar wrist pain when twisting?
Pain located in the ulnar side of the wrist usually has an associated trauma in the area. In most cases, the pain symptom gets worst when performing twisting movements and may even start with an exaggerated twisting motion during contact sports or overuse injuries over the course of weeks or months.
There’s a broad range of possible causes, depending on the structure affected on the ulnar side of the wrist. The main symptom is pain on the pinky side of the wrist and may or may not have an associated boney prominence. Tenderness in the area may indicate stress injury or bone fracture. In some cases, patients may also report that the bones move out of place or make a popping sound that is often associated with pain symptoms.
We can differentiate at least three medical conditions, one of them related primarily to the ulna and the remaining two directly involving the triangular fibrocartilage complex.
Ulnar Impaction syndrome
It is also known as ulnar abutment syndrome and causes long-standing pain in the outer region of the wrist that worsens and makes it difficult to perform natural twisting movements such as opening a doorknob.
The origin of ulnar impaction syndrome is a difference of length between the radius and the ulna. The ulna is usually more elongated and creates an anatomic defect that results in an uneven surface in the wrist joint.
This is a congenital abnormality and does not mean that every patient with this anatomic variation will have chronic ulnar wrist pain. Instead, they are more susceptible to injuries in the wrist articulation and would develop the pain symptoms after a fall or trauma to the hand or wrist.
It is essential to diagnose and treat this condition as soon as possible because having an uneven surface in the articulation of the wrist involves excess stress on the joint. The resulting alteration to the triangular fibrocartilage complex becomes worse when the problem is not properly treated. Thus, do not neglect your symptoms and talk to your doctor to get a series of diagnostic tests and trace the origin of your wrist pain.
Traumatic injuries to the triangular fibrocartilage complex
There are various types of traumatic injuries to the triangular fibrocartilage complex, depending on the severity. They range from a simple tear or perforation to a combination of ligament tear with a fracture in the ulnar styloid process and more severe tears that make the wrist articulation loose and unstable.
These traumatic injuries are more common in athletic patients and those undergoing certain types of trauma.
Degenerative injuries to the triangular fibrocartilage complex
Contrary to traumatic injuries, degenerative lesions to the triangular fibrocartilage complex develop over the course of weeks, months or years. All of them consist of tears further classified in various stages depending on whether or not there’s a perforation in the triangular fibrocartilage complex, an alteration to the ulnar head, degenerative arthritis, and other mounting joint problems.
The ulnar impaction syndrome is usually behind this subtype of injuries but may be caused by inflammatory conditions as well, such as rheumatoid arthritis and other degenerative process such as osteoarthritis.
How you can Treat Ulnar-sided wrist pain!
There are certain home measures to manage the symptoms of ulnar-sided wrist pain, including resting the articulation and applying ice. However, this type of pain should be assessed by a doctor because it is likely to become worse.
The first stage of the treatment is usually conservative management lasting around 3 months. It consists of resting the articulation, applying ice and immobilising the articulation for a few weeks followed by physical therapy.
When conservative treatment does not successfully improve the symptoms, surgery is the next option. However, it is contraindicated in unhealthy patients not likely to endure complex surgery or patients with minimal symptoms, even if they do have radiographical findings.
|Type of injury||Description||
|Aggressive twisting motion||Traumatic injury to the triangular fibrocartilage complex||A perforation or a ligament tear with or without fracture||Usually starts with a conservative treatment followed by physiotherapy.
Surgery is recommended when the symptoms are still significant or crippling
|Ulnar Impaction syndrome||Degenerative injury to the triangular fibrocartilage complex||A wear and tear or simple overuse injury with various types of degenerative changes|
Vezeridis, P. S., Yoshioka, H., Han, R., & Blazar, P. (2010). Ulnar-sided wrist pain. Part I: anatomy and physical examination. Skeletal radiology, 39(8), 733-745.
Watanabe, A., Souza, F., Vezeridis, P. S., Blazar, P., & Yoshioka, H. (2010). Ulnar-sided wrist pain. II. Clinical imaging and treatment. Skeletal radiology, 39(9), 837-857.
Yamabe, E., Nakamura, T., Pham, P., & Yoshioka, H. (2012, September). The athlete’s wrist: ulnar-sided pain. In Seminars in musculoskeletal radiology (Vol. 16, No. 04, pp. 331-337). Thieme Medical Publishers.
Sachar, K. (2012). Ulnar-sided wrist pain: evaluation and treatment of triangular fibrocartilage complex tears, ulnocarpal impaction syndrome, and lunotriquetral ligament tears. The Journal of hand surgery, 37(7), 1489-1500.