Ulnar Wrist Pain

What is ulnar wrist pain?

Ulnar wrist pain occurs on the outside (pinkie-finger side) of your wrist. The ulna is the arm bone that ends at the wrist on this side.

What are the signs and symptoms of a medical problem of the ulnar wrist?

Ulnar wrist pain, while at rest or with movement, is a common sign of many different injuries and medical conditions. Common signs and symptoms of ulnar wrist pain include:

• Pain on the pinkie-finger side of the wrist
• Popping or clicking noise in your wrist associated with sharp pain with movement
• Loss of strength in the hand when gripping strongly, associated with pain
• Loss of movement at the wrist especially with rotation of the forearm and with lateral movement of the wrist towards the pinky side (ulnar deviation)

What are the possible causes of ulnar wrist pain?

Many different injuries and medical conditions can cause pain on the outside of your wrist. They include:

• Arthritis. Inflammation (swelling) and stiffness in the wrist joint. This may include osteoarthritis (wear and tear of the cartilage of bones in the wrist joint), inflammatory arthritis, such as rheumatoid arthritis, or arthritis due to crystal deposits in the joint from gout or pseudo-gout.
• Fractures. Broken wrist or hand bones, or the end result of old fractures involving the ulnar styloid, hook of hamate or pisiform bones.
• Nerve injuries or compression. Damage to or pressure on nerves in the wrist, or higher in the arm or neck, resulting in irritation of the ulnar nerve.
• Overuse. Damaged tendons and ligaments due to repeated hand and arm motions or injuries.
• Triangular fibrocartilage complex (TFCC) injury. Tears or fraying in the tissues that connect the ulna to other parts of the wrist, often from a fall onto the wrist, or multiple repetitive twisting injuries. This can also result from a developmental difference in the length of the ulna compared with the adjacent radius in the forearm.
• Ulnar impaction syndrome. Wear and tear of cartilage and ligaments, caused by extra pressure when the ulna is longer than the other forearm bone.
• Growths. Masses including ganglion cysts (noncancerous tumors).
• Ulnar artery thrombosis. Blood clot in the ulnar artery.
• Kienbock’s disease. Loss of blood supply leading to the death of the lunate bone on the ulnar side of the wrist.
• Infection. From a prior penetrating injury or underlying condition that lowered resistance to developing an infection.

How is ulnar wrist pain diagnosed?

Doctors diagnose ulnar wrist pain based on your medical history and results of a physical exam. Some of the questions your doctor may ask include:

• Do you have any medical conditions that might contribute to your wrist pain, such as gout, diabetes or history of infections?
• Have you had any previous wrist injuries?
• Did the wrist pain come on suddenly or has the pain been present for a long period of time (days, weeks or longer)?
• Did a specific event occur that directly resulted in the wrist pain?
• How severe is the pain?
• Does your work or hobbies require repetitive wrist motion?

Your doctor will feel your wrist and area around it and make note of any swelling, redness, masses, scars, tenderness and any other signs of deformity. He or she will also perform several wrist movement tests to check range of motion, strength, and source of pain to help make the diagnosis.

Imaging tests will also be ordered. Imaging tests may include:

• X-rays to show the relationship between bones in the arm and wrist to identify fractures, arthritis, deformities, signs of infection or tumors.
• Computed tomography (CT)to reveal subtle fractures, fracture healing, abnormal alignment of bones, assess ligaments for tears, check artery blood flow for blockages.
• Magnetic resonance imaging (MRI) to check for abnormal growths and soft-tissue injuries (tendons, ligaments, blood vessels, nerves).
• Ultrasound to identify foreign bodies in the wrist area, tendon ruptures, tendinitis, compressed nerves, check blood flow, assess abnormal growths.
• Wrist arthrography uses a radiopaque fluid injected into the joint to enhance view of the joint structures before performing many of the above imaging studies.

How is ulnar wrist pain managed or treated?

Treatment for ulnar wrist pain depends on the cause. Standard treatments to relieve pain include:

• Taking anti-inflammatory medication, such as naproxen or ibuprofen or newer non-steroidal anti-inflammatory drugs (NSAIDS), or steroid injections to ease pain
• Changing your hand’s position during repetitive motions (ergonomic adjustment)
• Physical therapy (exercises to mobilize, strengthen tendons and ligaments in the wrist)
• Casting or splinting to rest the wrist
• Surgery to remove a growth or other cause of nerve compression, repair tendon or ligament tears, fix fractures or treat arthritis through open or arthroscopic surgery including forms of joint replacement

When should I call the doctor?

Contact your doctor if you have ulnar wrist pain that interferes with work or other daily activities, or is severe enough to impair motion and function, wakes you from sleep, or is associated with significant swelling, redness and fluid drainage.