Understand the little-finger side of your wrist, recognise warning signs and explore proven treatments that help you return to work, sport and everyday life.
What is ulnar wrist pain?
Pain on the palm or back of the wrist nearest the little finger is called ulnar-sided wrist pain. About one in four wrist problems seen in hand clinics involve this area. It often worsens with twisting, gripping or press-ups.
Key anatomy in plain English
• Distal radioulnar joint (DRUJ) – the pivot that lets your forearm turn palm up or down.
• Triangular fibrocartilage complex (TFCC) – a tough “shock absorber” disc with supporting ligaments that suspends the wrist from the ulna and shares load.
• Ulnar variance – how long the ulna is compared with the radius. Even a 2.5 mm longer ulna can almost treble the load through the TFCC and carpal bones.
Why do impaction syndromes develop?
If the ulna is longer (positive variance) it bumps into the TFCC, lunate and triquetrum with every grip or pronation movement. Over months this causes cartilage wear, small cysts and TFCC fraying – the picture known as Ulnar Impaction Syndrome (UIS). When only the styloid tip is too long the triquetrum is pinched, producing Ulnar Styloid Impaction Syndrome (USIS). Dynamic impaction can also occur in a neutral wrist during heavy grip or racket sports.
Main impaction syndromes
• Ulnar Impaction Syndrome – most common; linked to positive variance or a tilted distal radius.
• Ulnar Styloid Impaction Syndrome – excess styloid length pressing on the triquetrum.
• HALT disease – contact between a Type II lunate and the hamate, often in manual workers.
• Triquetrohamate Impaction Syndrome – rare; pain on the back-ulnar edge in two-handed sports such as golf.
Symptoms checklist
□ Aching or sharp pain on the little-finger side of the wrist
□ Worse with screwdriver-type twisting, grip or press-ups
□ Clicking, swelling or a feeling of weakness
□ Painful clunk during forearm rotation
When to seek medical advice
Consult a hand specialist if pain lasts more than two weeks, limits work or sport, follows a wrist fracture or is associated with swelling or night pain. Early assessment prevents cartilage damage.
How the diagnosis is made
Clinical tests
• Ulnocarpal Stress Test – wrist in full ulnar bend, gently loaded and rotated; reproduction of pain suggests impaction.
• Fovea sign – fingertip tenderness in the small hollow just beyond the ulna head.
Imaging
• Standard and pronated-grip X-rays show static and dynamic ulnar variance.
• MRI highlights TFCC tears, bone bruising and early cartilage change.
• Wrist arthroscopy remains the gold standard for confirming hamate arthrosis and grading TFCC wear.
First-line (non-operative) care
• Rest and a removable wrist splint for 4–6 weeks.• Avoid push-ups, heavy screw-driving and prolonged pronation.
• Anti-inflammatory tablets or gels.
• One ultrasound-guided steroid or PRP injection may ease inflammation.
• Physiotherapist-led programme: gentle stretches, then progressive grip and forearm-rotation strengthening.
Surgical options when pain persists
Procedure | Typical indication | Key points
Ulnar shortening osteotomy | Positive variance > 2–3 mm or combined impaction | Removes a small bone segment and fixes with a plate; considered the gold standard but carries a 5 % non-union risk.
Arthroscopic wafer resection | Positive variance ≤ 3 mm with good bone quality | Shaves 2–3 mm from the dome of the ulna; avoids hardware and offers quicker recovery.
Partial styloidectomy | Excess styloid impinging on triquetrum | Preserves ligaments and allows rapid return to desk work.
Hamate or triquetrum trimming | HALT or Triquetrohamate syndrome | Performed via keyhole surgery to relieve focal cartilage wear.
Typical recovery timeline
• Splint 2–4 weeks (long-arm if osteotomy).• Light activities from week 6.
• Driving and desk work by week 8.
• Sport and manual work 3–4 months once strength equals the other side.
CLINICAL PEARLS / KEY POINTS
• The TFCC can carry up to 42 % of wrist load when the ulna is only 2.5 mm longer than the radius.• Dynamic ulnar variance means even a normal-length ulna can impinge during forceful grip.
• Always X-ray in neutral and pronated-grip positions to uncover hidden variance.
• Non-union risk after osteotomy doubles in smokers.
• Early physiotherapy focusing on forearm rotation reduces stiffness.
PATIENT FAQS
Why does my wrist hurt only when I twist a jar?
Twisting tightens the TFCC and drives the longer ulna against the carpal bones, recreating the pinch.
Will splints weaken my wrist?
Short-term splints protect healing tissues; planned exercises prevent long-term weakness.
Can an injection cure the problem?
Steroid or PRP injections calm inflammation but cannot change bone length; symptoms often return if variance is high.
Is bone removal safe?
Yes. Surgeons remove or shorten only a few millimetres, preserving joint surfaces and stabilising ligaments.
How long before I can lift weights?
Most patients restart gym-based strengthening between three and four months, guided by their physiotherapist.
CALL-TO-ACTION
For personalised assessment or a second opinion, phone 020 3384 5588, email Info@TheArmDoc.co.uk, or visit www.TheArmDoc.co.uk/appointments. For home exercise videos, see our Wrist Rehabilitation hub.EVIDENCE & GUIDELINES
• 2024 Journal of Wrist Surgery Guidelines on Ulnar Impaction Syndrome• British Society for Surgery of the Hand Standards for Wrist Conditions, 2025
• NICE Quality Standard for Musculoskeletal Assessment, 2023
DISCLAIMER
This leaflet provides general information. It does not replace a full consultation, examination and personalised advice from a qualified medical professional. If you experience sudden swelling, loss of sensation or severe pain, seek urgent care.