Ulnar Wrist Pain / TFCC Tear / Ulnar Plus Variant

I have pain and swelling at the outside of my wrist

If you are experiencing pain at the outside of your wrist, that is the little finger side, you are suffering from ulnar wrist pain.

What is ulnar wrist pain and what is the TFCC?

The wrist is a complex structure consisting of 15 bones which are radius and ulna, 8 carpal bones and 5 metacarpal bones. Radius and ulna are the two bones of the forearm and the ulna serves as a post where the radius rotates around. This is called ‘supination’ (palm up) and ‘pronation’ (palm down). There is a cartilage structure at the wrist end of the ulna, which connects it with the radius and provides stability. This cartilage is called ‘TFCC’ (triangular fibrous cartilage complex). It is shaped like a disc and communicates with ulna on one side and two carpal bones on the other side (lunate and triquetrum). In close proximity to the TFCC are strong tendons that extends and flex the wrist (flexor & extensor carpi ulnaris). Any of theses structures, that are part of the ulnar side of the wrist, can cause ulnar wrist pain if damaged.

Who gets ulnar wrist pain and what is ulnar plus variant?

Traumatic events to the wrist can result in tearing of the TFCC or fracture of the tip of the ulna (ulna styloid). Besides the TFCC is subject to wear and tear and can cause chronic pain when a degenerative tear has occurred. Radius and ulnar have a length relationship where normally the radius is slightly prominent towards the wrist. In an anatomic variant called ‘Ulnar Plus Variant’, the ulnar is longer that the radius and this leads to increased pressure to TFCC and lunate and triquetrum. Ulnar wrist pain generated by this anatomical variant is called ‘carpal impaction syndrome’. In advanced stages the pressure can lead to damage of lunate with subsequent collapse of this carpal bone.

How is ulnar wrist pain diagnosed?

The history of a traumatic event with pain at the outside of wrist is the first clue. Stability of radius and ulna can be assessed as well as overall wrist range of motion, which often is reduced. X-rays will show the bony architecture and investigate for ‘ulnar plus variant’ and ultrasound is able to image inflammation of adjacent tendons (flexor & extensor carpi ulnaris tenosynovitis). MRI scan is the most comprehensive imaging study and can image pathology to TFCC, carpal bones and tendons.

Treatment for ulnar wrist pain

Pain due to inflammation can be managed with rest, optionally in a custom brace, and anti-inflammatory medication. Cortisone injections are worth a consideration and often pain will settle with these measures. In cases with chronic ulnar wrist pain, management depends on the individual pathology and surgery is an option.

Surgery for ulnar wrist pain

A lot of conditions such as chronic inflammation and TFCC tear can be treated via wrist arthroscopy as day surgery. Ulnar styloid fracture or pathology of carpal bones might a require an open approach where fractures can be fixed or and ulnar plus variant can be shortened.

Preparing for surgery for ulnar wrist pain

Some procedures require wrist immobilisation after surgery and we will arrange for fitment of a custom brace prior to the date of surgery. If required we will arrange for a bulk billed pre-admission clinic at the hospital. This is run by a specialist anaesthetist who will gather information and request investigations that are required for safe anaesthesia. Our reception staff will advise of costs, hospital and admission details.

Recovery from surgery for ulnar wrist pain

Postoperative management depends on the individual procedure. Some allow for immediate use of wrist and hand and others require some time of wrist immobilisation. In all cases a hand therapist will closely follow up with change of dressings and management of swelling. Further management will be discussed at the scheduled two week postoperative review appointment.