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Ulnar Wrist Pain

Ulnar Wrist Pain: What Should You Know?

Let us first discuss the anatomy and structure of the ulnar wrist and how it causes pain before letting you know about the causes, symptoms, and treatment of ulnar wrist pain. The anatomy of the ulnar wrist will help you identify if you’re really suffering from the ulnar wrist pain or if something else is wrong with your hand.

The wrist is a joint between your hand and forearm, but this joint is not as simple as it seems. The wrist consists of the distal radius, the ulna, the carpal bones, and the bases of the metacarpals. The ulna bone is the bone on the medial side of your forearm (pinky side), and the radius is on the thumb side. So, Ulnar wrist pain is the pain on the pinky side of your wrist.

What is Ulnar wrist pain?

Ulnar wrist pain is the pain on the pinky side of your wrist or the side opposite to the thumb. This pain is widespread among adults, resulting from damage to the hand or wrist bones, ligaments, tendons, or cartilage. The severity of the Ulnar wrist pain may vary depending on the causes or conditions like injuries of the distal radioulnar joint (DRUJ), irritation of the wrist tendons (extensor and flexor carpi ulnaris), Ulnar impaction syndrome, or wrist meniscus injuries of the triangular fibrocartilage complex (TFCC).

Types of Ulnar wrist pain:

Ulnar wrist pain can be acute or chronic depending upon the underlying causes:

  • Acute:  A painful twist of the wrist tendons or ligaments under a heavy load or a fall can result in a distal radioulnar joint (DRUJ) or triangular fibrocartilage complex (TFCC) injury. When the DRUJ is injured, patients may notice a prominence on the backside of their wrist. Small wrist bone cracks may result from a fall onto an extended or overstretched wrist or hand.
  • Chronic:  Long-term ulnar-sided wrist pain may result from an old injury to the wrist, hand, elbow, or an inflammatory condition. It may also result from congenital disabilities in the shape of the ulnar wrist. Extended overuse of the ulnar wrist can also lead to triangular fibrocartilage complex. Ulnar wrist pain tends to worsen with movement of the hand to the direction of the ulna (ulnar deviation).

What Are The Symptoms of Ulnar wrist pain?

Ulnar wrist pain may show many signs and symptoms like it may worsen when you twist your wrist or grip something in your hand. Some of the common symptoms of Ulnar wrist pain are:

  • Pain on the pinky side (Ulnar side) of the wrist with or without any movement
  • Decreased grip strength of your hand
  • Clicking or popping your wrist associated with sharp pain
  • Greater power turning the palm to the ground (pronation) compared to when turning the palm upwards (supination)
  • Decreased or limited motion at the wrist
  • Tenderness when pressure applied on wrist bones may indicate stress injury or fracture.

Common Causes

Finding the cause of your Ulnar wrist pain is your first step toward recovery. A communal cause of Ulnar wrist pain is a fall onto an overextended hand that can break or fracture your wrist bones.

Many different medical conditions and injuries can cause ulnar wrist pain. They include:

  1. Wrist injuries: No matter how severe or sensible your wrist joint pain is, there’s always a chance you have a wrist fracture or a broken wrist. Even if you can still move your wrist, it may be broken without you having any idea of the fracture. Postponing the treatment of your broken wrist may be injurious, so visit a hand surgeon as soon as you are feeling pain. A common cause of ulnar wrist pain is a fall onto an outstretched hand. This can break bones in the wrist.
  2. Triangular Fibrocartilage Complex or TFCC tear: The TFCC is a chief structure that helps connect the forearm with the small ulnar side bones of the wrist. Tearing or wearing of the TFCC, often from multiple repetitive twisting injuries or a fall onto the wrist, can cause Ulnar-sided wrist pain. This can also result from a developmental variance in the ulna length compared with the radius bone in the forearm.
  3. Arthritis of joints: Arthritis is the wrist joint‘s stiffness and Inflammation (swelling). Many types of arthritis can cause pain in the ulnar side of the wrist. This may include inflammatory arthritis (such as rheumatoid arthritis), osteoarthritis (tear of the cartilage of bones in the wrist joint), or arthritis due to crystal deposits in the joint from gout.
  4. Nerve injury or compression: Nerves can be damaged by too much compression or pressure, stretching, or simply by a cut that causes ulnar wrist pain, irritation of the ulnar nerve, numbness, or weakness in the wrist.
  5. Ulnar tunnel syndrome: Usually, the symptoms of clumsiness, numbness, burning, and pain in the Ulnar side of the hand occur at the same time as on the opposite side of the hand; i.e., as a person with carpal tunnel syndrome. It is a controversial point except when excluding ulnar nerve entrapment at the cubital tunnel. This may be because carpal tunnel release concurrently expands the ulnar nerve in the Guyon’s canal. Guyon’s canal also called the Ulnar tunnel, is right next to the carpal tunnel, separated only by a septum.
  6. Piso-Triquetral Arthritis: It is a rare small joint degenerative arthritis that occurs between the pisiform and the triquetrum. The pisiform is an extra bone that can be removed surgically to relieve discomfort.
  7. Inflammation or wrist infection: Inflammation from a preceding penetrating injury or underlying condition can lower the resistance to developing an infection at the wrist joint.
  8. Cubital tunnel syndrome: Cubital tunnel syndrome (entrapment of the Ulnar nerve at the elbow) occurs more in women than men. It tends to happen in a person who sleeps with their elbow flexed (bent).
  9. Ulnar impaction syndrome: Those who suffer from Ulnar Impaction Syndrome have an ulna bone that is longer than the radius bone, which can cause it to knock into the smaller wrist bones (carpals). 
  10. Distal RadioUlnar Joint (DRUJ) Arthritis: On the Ulnar side of the wrist, a rare form of instability (known as lunotriquetral instability) may develop. This may also result in wrist pain.
  11. Kienbock’s disease: The loss of blood supply leads to the death of the lunate bone on the wrist’s ulnar side.
  12. Extensor Carpi Ulnaris Tendinosis: The extensor carpi ulnaris is a critical muscle in lifting the wrist and tilting to the pinkie side of the hand (the most functional position for the hand).
  13. Ganglion cyst: A small fluid-filled deteriorating sac bulging from a tendon sheath or a joint. Ganglion cyst frequently occurs on the wrist and causes wrist pain.

Diagnosis of Ulnar wrist pain:

Ulnar wrist-sided pain can be hard to diagnose because it can be associated with many injuries. Your hand doctor will inspect your wrist to see the actual location of the pain and how your wrist moves. Many imaging tests can be ordered, including:

  • X-rays (radiographs) to see the connection between bones in the forearm and wrist to identify fractures, deformities, and arthritis.
  • Magnetic Resonance Imaging (MRI) to check for irregular growths and soft-tissue injuries.
  • Ultrasound to identify tendon ruptures, foreign bodies in the wrist area, and compressed nerves.
  • Computed tomography (CT) reveals delicate fractures, abnormal alignment of bones, and artery blood flow for obstructions.
  • Wrist arthrography uses a radio-opaque fluid injected into the joint to improve the view of the joint structures.

Treatment Options

Treatment greatly depends on the leading cause. Standard treatment options to relieve pain include:

  • Rest to allow for self-healing
  • Taking some anti-inflammatory medication (ibuprofen), newer NSAIDs, or steroid injections to ease pain
  • Physical therapy (exercises to mobilise, activity modification, and strengthen tendons – improves range of motion.
  • Changing your hand’s position during repetitive motions
  • Casting or splinting for broken bones
  • Surgery to remove a mass or other nerve compression cause, fix fractures, repair ligament tears, or treat arthritis through open or arthroscopic surgery.

When to see an orthopaedic?

Wrist pain typically predominates after hours of unceasingly using your wrists without resting. However, suppose the pain continues despite giving your wrists some rest, interferes with everyday work or other activities, or is severe enough to alter your hand’s motion and normal functions. In that case, you should see your orthopaedic doctor as soon as possible for a thorough physical examination and accurate diagnosis.

Frequently Asked Questions:

How do you fix ulnar-sided wrist pain?

To fix your ulnar-sided wrist pain, first, you need to know its leading cause. The treatment of ulnar-sided wrist pain entirely depends on its root cause. Hopefully, you can relieve your ulnar sided wrist pain by:

  • Physical therapy
  • anti-inflammatory medication
  • casting or sprinting
  • steroid injections
  • lifestyle modifications to reduce wrist movement and allow self-healing

Will ulnar wrist pain go away?

Diagnosis of the root cause of the ulnar wrist pain is essential to relieve the pain. Some physical or occupational therapies can help you reduce the pain. If you have mild wrist pain, proper rest, splinting, and anti-inflammatory medications can reduce the symptoms and pain in your wrist. However, if you opt for surgery, it might take some months to heal it entirely. So, with proper treatment and care, you can completely defeat your ulnar wrist pain.

What causes ulnar-sided wrist pain?

Many different injuries can cause ulnar-sided wrist pain, but a common cause is falling onto an over-extended hand. Some possible causes of ulnar-sided wrist pain are:

  • fractures (broken wrist bone)
  • Ulnar impaction syndrome
  • Arthritis (inflammation in the wrist joint)
  • Infection
  • Repeated hand motion
  • Ulnar artery thrombosis
  • Nerve injury
  • triangular fibrocartilage complex (TFCC) tear

What does ulnar tendonitis feel like?

If you have ulnar tendonitis, you may feel pain and a clicking noise on the pinkie-finger side of your wrist. You may also lose strength in your affected hand when gripping anything. The movement at the wrist towards the pinky side may also be lost.

Will the ulnar nerve heal itself?

The symptoms of the ulnar nerve entrapment can be relieved by proper medication and rest, but the full recovery of the ulnar nerve may take some months. The recovery of ulnar nerve damage depends on its leading cause and the severity of the injury. But with a proper and timely diagnosis, you can make a complete recovery if taken care of properly.

How do I know if I have ulnar nerve entrapment?

The symptoms of ulnar nerve entrapment are:

  • Tingling in the palm
  • intermittent pain in the ring and little finger
  • sensitivity to cold
  • Tenderness in the elbow joint
  • Numbness in the pinky finger
  • Weakness and sensitivity to the hand

If you feel a continuous and sharp pain in the pinky side of your hand, you should visit your doctor for a timely diagnosis and treatment. Your doctor may ask for an ultrasound or MRI to confirm if you have ulnar nerve entrapment or not.

 

References

  1. Care, H. (2022). Ulnar wrist pain: Causes and treatment: The hand society. Causes and Treatment | The Hand Society. Retrieved April 2, 2022, from https://www.assh.org/
  2. Clinic, M. (2022, March 26). Ulnar wrist pain. Mayo Clinic. Retrieved April 2, 2022, from https://www.mayoclinic.org
  3. Center , A. (2021, May 7). At what point does ulnar sided wrist pain require surgery: Arizona Center. Arizona Center for hand to shoulder surgery. Retrieved April 2, 2022, from https://achssurgeons.com/
  4. Clinic, C. (2022). Ulnar wrist pain. Cleveland Clinic. Retrieved April 2, 2022, from https://my.clevelandclinic.org/
  5.  American Society for Surgery of the Hand . The hand: examination and diagnosis. 3. New York: Elsevier; 1990. [Google Scholar] [Ref list]

Tanaka T, Ogino S, Yoshioka H. Ligamentous injuries of the wrist. Semin Musculoskelet Radiol. 2008; 12 :359–377. doi: 10.1055/s-0028-1100642. [PubMed]

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