Ulnar Wrist Pain: Causes, Symptoms, Diagnosis, and Treatment

Why does my ulna hurt when I move my wrist?

Pain on the ulnar side (pinky finger side) of the wrist when moving it often indicates an issue with the complex structures that stabilize this joint, most commonly involving the Triangular Fibrocartilage Complex (TFCC), tendons, or the articulation between the ulna and carpal bones.

Understanding Wrist Anatomy and the Ulna

The wrist is a highly intricate joint, comprising eight carpal bones, the distal ends of the radius (thumb side forearm bone), and the ulna (pinky finger side forearm bone). While the radius bears the majority of the load from the hand, the ulna plays a crucial role in wrist stability, rotation, and specific movements. On the ulnar side of the wrist, a complex of ligaments and cartilage known as the Triangular Fibrocartilage Complex (TFCC) acts as a critical shock absorber, stabilizer, and pivot point, connecting the ulna to the carpal bones (primarily the lunate and triquetrum). Various tendons, such as the Extensor Carpi Ulnaris (ECU), also cross this region, contributing to wrist movement and stability.

Common Causes of Ulnar Wrist Pain

Pain on the ulnar side of the wrist can stem from a variety of issues, often exacerbated by wrist movement.

• Triangular Fibrocartilage Complex (TFCC) Injury: This is arguably the most common cause of ulnar-sided wrist pain, particularly in athletes and individuals involved in repetitive gripping, twisting, or impact activities.

  • Mechanism: Injuries can be traumatic (e.g., fall on an outstretched hand, forceful twist) or degenerative (due to repetitive stress or aging).
  • Symptoms: Pain is often sharp with twisting movements (like opening a jar, turning a doorknob), weight-bearing (push-ups), or ulnar deviation (bending the wrist towards the pinky finger). Clicking, grinding, or a sensation of instability may also be present.

• Ulnar Impaction Syndrome (Ulnar Abutment Syndrome): This condition occurs when the ulna is relatively longer than the radius at the wrist joint (a positive ulnar variance), causing the ulna to "impact" or abut against the carpal bones (lunate and triquetrum) and the TFCC with wrist movements.

  • Mechanism: Can be congenital or acquired (e.g., after a radius fracture that shortens the radius). Repetitive pronation, gripping, and ulnar deviation increase the impaction.
  • Symptoms: Chronic, aching pain on the ulnar side, worse with gripping, pronation, and ulnar deviation. Degeneration or tears of the TFCC are common secondary findings.

• Extensor Carpi Ulnaris (ECU) Tendinopathy/Subluxation: The ECU tendon runs along the ulnar side of the wrist and is involved in wrist extension and ulnar deviation.

  • Mechanism: Tendinopathy (inflammation or degeneration) results from overuse or repetitive strain. Subluxation (snapping out of place) can occur if the sheath holding the tendon in its groove is torn or stretched, often felt as a painful "clunk" or "snap" during forearm rotation or wrist movement.
  • Symptoms: Pain, tenderness, and sometimes swelling over the ECU tendon, particularly with resisted wrist extension and ulnar deviation. A palpable click or snap may be felt with subluxation.

• Ganglion Cysts: These are benign, fluid-filled sacs that can develop near joints or tendons, including on the ulnar side of the wrist.

  • Mechanism: Their exact cause is unknown but may be related to joint or tendon sheath irritation.
  • Symptoms: A visible or palpable lump, which may or may not be painful. Pain can occur if the cyst presses on a nerve or interferes with joint movement.

• Fractures: While less common for chronic pain, a subtle or stress fracture of the distal ulna or an adjacent carpal bone (like the hamate or triquetrum) can cause pain with movement.

  • Mechanism: Acute trauma (fall) or repetitive stress (stress fracture).
  • Symptoms: Localized pain, swelling, tenderness, and often difficulty with weight-bearing or specific wrist movements.

• Arthritis: Degenerative (osteoarthritis) or inflammatory (rheumatoid arthritis) conditions can affect the small joints of the wrist, including those involving the ulna.

  • Mechanism: Cartilage breakdown (osteoarthritis) or autoimmune inflammation (rheumatoid arthritis).
  • Symptoms: Joint stiffness, aching pain, swelling, and reduced range of motion, often worse in the morning or after periods of inactivity.

• Nerve Entrapment (Ulnar Nerve): Though less common, compression of the ulnar nerve at the wrist (Guyon's canal syndrome) can sometimes cause pain that refers to the ulnar side of the wrist, along with numbness or tingling in the pinky and ring fingers.

  • Mechanism: Compression from repetitive pressure, trauma, or space-occupying lesions.
  • Symptoms: Pain, numbness, tingling, or weakness in the pinky and half of the ring finger, which may extend to the wrist.

• Kienbock's Disease: This is a rare condition involving the progressive collapse of the lunate bone (one of the carpal bones) due to a disruption of its blood supply. While the lunate is not the ulna, its collapse can alter wrist mechanics and lead to pain on the ulnar side, especially in cases of negative ulnar variance.

  • Mechanism: Poor blood supply to the lunate, leading to avascular necrosis.
  • Symptoms: Deep, aching wrist pain, stiffness, and weakness, often worsening over time.

Symptoms Often Associated with Ulnar Wrist Pain

Beyond the pain itself, you might experience:

• Clicking, popping, or grinding sensations during wrist movement.
• Swelling or tenderness on the ulnar side of the wrist.
• Weakness when gripping objects or performing wrist movements.
• Reduced range of motion, particularly with twisting, ulnar deviation, or weight-bearing.
• Instability or a feeling that the wrist is "giving way."
• Numbness or tingling in the pinky and ring fingers (less common, but indicates potential nerve involvement).

When to Seek Professional Medical Advice

While some mild wrist pain may resolve with rest, it is crucial to consult a healthcare professional, such as a sports medicine physician, orthopedist, or physical therapist, if:

• The pain is severe or debilitating.
• Symptoms persist for more than a few days despite rest and self-care.
• There is significant swelling, bruising, or deformity.
• You experienced a sudden injury or trauma.
• You experience numbness, tingling, or weakness.
• The pain interferes with daily activities or training.

Early and accurate diagnosis is key to effective treatment and preventing chronic issues or further damage.

Initial Self-Care and Management

For acute, mild pain, you can try the following initial steps:

• Rest: Avoid activities that aggravate the pain, especially repetitive twisting, gripping, or weight-bearing through the wrist.
• Ice: Apply ice packs to the affected area for 15-20 minutes several times a day to reduce inflammation and pain.
• Compression: Use a compression bandage or wrist brace to provide support and reduce swelling.
• Elevation: Elevate your hand and wrist above your heart, especially when resting.
• Over-the-counter pain relievers: Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help manage pain and inflammation.

Diagnosis and Treatment Options

A healthcare professional will typically conduct a thorough physical examination, including specific tests to assess wrist stability, range of motion, and tenderness. Imaging studies such as X-rays, MRI, or CT scans may be ordered to visualize bone, cartilage, and soft tissue structures.

Treatment depends on the underlying cause and severity:

• Conservative Management: This often includes activity modification, immobilization (splint or brace), physical therapy (to improve strength, flexibility, and stability), NSAIDs, and sometimes corticosteroid injections.
• Surgical Intervention: In cases of severe tears (e.g., TFCC), persistent impaction, unstable fractures, or failed conservative treatment, surgery may be recommended to repair structures, decompress nerves, or address bone abnormalities.

Preventative Measures and Long-Term Strategies

To minimize the risk of ulnar wrist pain, especially for those engaged in repetitive activities or sports:

• Proper Technique: Ensure correct form during exercises, sports, and occupational tasks to avoid undue stress on the wrist.
• Gradual Progression: Increase training intensity and volume gradually to allow tissues to adapt.
• Strengthening and Flexibility: Incorporate exercises that strengthen the forearm muscles (flexors and extensors), wrist stabilizers, and improve wrist mobility.
• Ergonomics: Optimize your workspace and tools to reduce repetitive strain on the wrist.
• Listen to Your Body: Do not push through pain. Address discomfort early with rest and modification.
• Cross-Training: Vary your activities to reduce repetitive stress on specific joints and muscle groups.

Conclusion

Pain on the ulnar side of the wrist with movement is a common complaint with a variety of potential causes, ranging from acute injuries to degenerative conditions. Given the complexity and critical function of the wrist, it is essential to seek a professional diagnosis if you experience persistent or severe pain. An accurate assessment will guide the most effective treatment plan, helping you return to pain-free movement and maintain long-term wrist health.