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Ulnar-Sided Wrist Pain (Ulnar Impaction Syndrome)

Ulnar impaction syndrome occurs when the ulna bone (forearm bone on pinky side) is too long relative to the radius bone, causing excessive pressure on the ulnar side of the wrist - this leads to pain on the pinky side of the wrist, worse with gripping, twisting, and leaning on the hand - the extra-long ulna damages the triangular fibrocartilage (TFCC) and wrist cartilage over time - conservative treatment (activity modification, wrist splinting, corticosteroid injections) provides temporary relief in 30-50% of patients, while persistent symptoms are treated with surgery to shorten the ulna bone (ulnar shortening osteotomy) achieving 80-85% good outcomes.

📅Last reviewed: January 2026đŸĨBones & Joints

📖What is Ulnar-Sided Wrist Pain (Ulnar Impaction Syndrome)?

Ulnar impaction syndrome occurs when the ulna bone (forearm bone on pinky side) is too long relative to the radius bone, causing excessive pressure on the ulnar side of the wrist - this leads to pain on the pinky side of the wrist, worse with gripping, twisting, and leaning on the hand - the extra-long ulna damages the triangular fibrocartilage (TFCC) and wrist cartilage over time - conservative treatment (activity modification, wrist splinting, corticosteroid injections) provides temporary relief in 30-50% of patients, while persistent symptoms are treated with surgery to shorten the ulna bone (ulnar shortening osteotomy) achieving 80-85% good outcomes.

đŸ”ŦWhat Causes It?

  • Positive ulnar variance (ulna bone 2-4mm longer than radius) causing excessive load on ulnar wrist
  • Radial head fracture causing radius shortening and relative ulnar lengthening
  • Distal radius fracture malunion (healed short) making ulna appear longer
  • Premature closure of radial growth plate (childhood injuries) causing ulna overgrowth
  • Repetitive pronation and gripping activities (gymnastics, racquet sports) accelerating cartilage damage

âš ī¸Risk Factors

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You may be at higher risk if:

  • Positive ulnar variance on X-rays (ulna longer than radius by 2mm or more)
  • Gymnastics, racquet sports, manual labor (repetitive impact loading on wrist)
  • Previous distal radius fractures (especially malunions healing short)
  • Previous radial head fractures or excision (causes relative ulna lengthening)
  • Age 30-50 years (cumulative cartilage damage from years of abnormal loading)

đŸ›Ąī¸Prevention

  • ✓Avoid repetitive pronation and gripping activities if possible
  • ✓Use proper technique and ergonomic equipment for manual labor
  • ✓Treat distal radius fractures anatomically (prevent malunion causing relative ulnar lengthening)
  • ✓Address radial head fractures promptly (excision causes ulnar impaction)
  • ✓Strengthen wrist muscles and improve proprioception