What Is Ulnar Wrist Pain?

Ulnar wrist pain refers to discomfort or pain that is experienced in the ulnar side of the wrist. This type of pain can often have various causes, such as trauma, overuse, arthritis, nerve compression, or the presence of ganglion cysts.

Overview 

The forearm is made up of two bones: the radius and the ulna. The ulna is the thinner of the two bones and is on the same side as the little finger. Thus, the ulnar side of the wrist is the side with the little finger. 

Ulnar wrist pain is relatively common in adults but not in children.  

Ulnar wrist pain, during movement or rest, is a common symptom of many different injuries and medical conditions. It can be a result of injury to bones, cartilage, ligaments, tendons, nerves or blood vessels.¹

Symptoms of ulnar wrist pain

The symptoms of ulnar wrist pain can vary depending on the underlying cause and the severity of the condition. The typical symptoms of ulnar-sided wrist pain include:

• Pain: the most prominent symptom is pain on the ulnar side of the wrist, ranging from mild discomfort to severe, sharp pain, depending on the cause. Pain may become more pronounced during certain wrist movements or activities.
• Tenderness: the affected area may be tender to the touch, and pressure on the ulnar side of the wrist can exacerbate the discomfort
• Swelling: swelling or inflammation in the wrist may occur, leading to visible puffiness or a feeling of fullness in the affected area
• Weakness: Ulnar's wrist pain can result in weakness in the hand and wrist. There may be difficulty in gripping objects, performing fine motor tasks, or sustaining a strong grip.
• Limited range of motion: restricted mobility in the wrist joint can make it challenging to fully flex, extend, or rotate the wrist
• Numbness and tingling: ulnar wrist pain due to nerve compression can cause numbness or tingling sensations, typically in the little finger and sometimes on the outside of the ring finger
• Stiffness: stiffness in the wrist joint, especially in the morning or after periods of inactivity, is a symptom commonly associated with ulnar wrist pain caused by arthritis

Causes of ulnar wrist pain 

There are many conditions and numerous types of wrist injuries occurring in a small region that can cause ulnar-sided wrist pain, which makes finding the specific cause quite challenging. 

The main causes include:

• Traumatic injuries: common injuries that can cause ulnar wrist pain include fractures, sprains and strains and are often a result of falls, sports injuries, or accidents
• Overuse injuries: repetitive motions or activities involving the wrist, such as typing, gripping tools, or playing musical instruments, can lead to overuse injuries like tendonitis or carpal tunnel syndrome
• Arthritis: conditions such as rheumatoid arthritis or osteoarthritis can cause joint swelling and pain in the ulnar side of the wrist:
  • Osteoarthritis is caused by a disease process leading to degeneration of the cartilage and, eventually, bones in the wrist joint.
  • Rheumatoid arthritis is an inflammatory arthritis that causes swelling and stiffness in the joint, leading to pain and difficulty in movement.
• Ulnar impaction syndrome: occurs when the ulna bone is longer than the radius bone, causing extra pressure on the wrist joint – the ulna bone ‘bumps into’  the smaller carpals (wrist bones), which leads to pain and discomfort 6  It can occur in such people as those who have a congenital positioning of the end of the ulna bone more distant from the elbow than the end of the radius, or individuals with a shortened radius bone due to poor healing of a past fracture. 
• Triangular fibrocartilage complex (TFCC) injury: is often a result of repeated twisting injuries or falls onto the wrist, which results in the tissues that connect the ulna to other regions of the wrist tearing.
• Nerve compression: Ulnar nerve compression can lead to pain, numbness and tingling in the ulnar aspect of the wrist and hand and weakness of some small muscles within the hand. Damage or prolonged pressure on nerves within the wrist or higher up in the arm can result in irritation of the ulnar nerve. Similarly, compression of the nerve roots arising from the lower cervical and upper thoracic vertebrae (C8 to T1) (the spinal bones forming the junction between the base of the neck and top of the back) and compression in parts of the brachial plexus ( the ‘junction box’ for the nerves leading to the arm) which supply the ulnar nerve can both lead to the symptoms described as  thoracic outlet syndrome ²
• Ganglion cysts: these fluid-filled sacs can develop near the wrist joint and exert pressure on surrounding structures, causing pain
• Ulnar artery thrombosis: a blood clot in the ulnar artery can block blood supply and cause pain
• Kienbock’s disease: the loss of blood supply leads to the necrosis (death) of the lunate bone (one of the bones in the wrist) on the ulnar side of the wrist and thus pain.^{1, 2, 7}

Diagnosis of ulnar wrist pain

The differential diagnosis of ulnar-sided wrist pain is a difficult process due to the large number of structures in a small area that can generate pain and numerous causes that can result in pain in this region. A thorough history-taking and complete physical examination followed by appropriate imaging studies will help the practitioner confirm a diagnosis to inform treatment of the conditions causing the pain.²  

• History and examination: the diagnosis of the cause of ulnar wrist pain based on history and examination is comparatively more difficult than radial-sided wrist pain and requires advanced imaging to confirm the diagnosis.³ 

A focused history and a physical examination based on the surface anatomy of the ulnar side of the wrist and provocative testing can help the healthcare practitioner make a list of the possible differential diagnoses even before getting imaging. 

The physical examination should be performed while keeping in mind the various bones, ligaments, tendons, and the neurovascular system on the ulnar side of the wrist that could generate pain. 

Exam techniques that can be used include grip strength testing, inspection, and both active and passive range of motion (asking the patient to actively move the wrist through the full range of possible motions and then making the patient’s wrist move passively by the examiner repeating the wrist movements for the patient. 

The careful probing of all ulnar-side wrist structures based on a knowledge of anatomy and comparison with the opposite side is the most effective diagnostic technique.⁴

• Imaging studies may be necessary to get a closer look at the wrist and identify any structural issues.⁵ Commonly used imaging modalities for ulnar wrist pain include:
  •  X-rays: X-rays can help identify fractures, dislocations, malalignments or signs of arthritis
  • Magnetic Resonance Imaging (MRI): MRI is useful for evaluating soft tissue injuries, such as ligament, tendon or cartilage damage
  • Ultrasound: ultrasound can provide real-time images of the wrist during movement and can be particularly helpful for assessing soft tissue problems.⁷

• Nerve conduction studies may be conducted to assess nerve function by measuring their electrical activity in cases of suspected nerve compression.
• Arthroscopy: in some situations, a minimally invasive surgical procedure called arthroscopy may be used to directly visualise and diagnose wrist joint issues. This involves inserting a small camera through a tiny incision to examine the joint's interior⁷

Management and treatment 

The treatment for ulnar wrist pain depends on the cause diagnosed and severity of the condition. Standard treatments to relieve pain include:

• Rest and immobilization
• Splinting or bracing for wrist support
• Physiotherapy involves exercises to mobilize and strengthen tendons and ligaments in the wrist thereby strengthening it and improving wrist function.
• Medications for pain and inflammation: such as anti-inflammatory medications like ibuprofen or naproxen to reduce pain or other non-steroidal anti-inflammatory pharmaceuticals (NSAIDS). Corticosteroid injections are also used for persistent pain.
• Surgical intervention may be necessary in severe cases to treat arthritis with open or arthroscopic procedures. These include types of joint replacement, removing a growth or other causes of nerve compression, mending tendon or ligament tears, fixing fractures, and other repairs⁷

Prevention of ulnar wrist pain

To prevent ulnar wrist pain, it can be useful to consider:

• Ergonomic workspace setups to reduce strain during work. This includes workstation assessment and set-up at a computer.
• Proper hand and wrist positioning during activities
• Regular stretching and strengthening exercises
• Lifestyle adjustments, such as maintaining a healthy weight and avoiding repetitive motions 

Complications

Ignoring ulnar wrist pain can lead to chronic (long-term) discomfort and functional limitations (inability to do various daily and occupational activities such as typing or using power tools). In severe cases, surgery may be necessary, and the outcomes of this can vary based on the individual, the nature of the problem, and the period that it has been left untreated.⁷

Summary

Wrist pain on the ulnar side of the arm is a symptom that occurs commonly in many adults who find it can become a persistent issue. Accurate diagnosis is challenging and requires thorough history-taking, anatomical knowledge to inform palpation of the area and a methodical physical examination. The diagnosis then needs to be confirmed through imaging. 

The origin of the ulnar wrist pain and its intensity can affect the symptoms experienced. Injuries (such as sprains, strains and fractures), as well as conditions such as ulnar impaction syndrome, arthritis, nerve compressions at various points along the course of the ulnar nerve and repetitive strain through overuse, are common causes. 

Generally, skilfully administered treatment leads to a resolution or improvement of symptoms, but sometimes surgical interventions are required. The excellent outcomes that can currently be achieved are attributed to advancements in wrist research and surgical technique over the last ten years.