Ulnar Impaction Syndrome

Ulnar impaction syndrome is a condition where the ulna (the smaller forearm bone on the little finger side) places increased pressure on the structures of the wrist.

This can lead to irritation and damage to the cartilage and soft tissues, particularly the triangular fibrocartilage complex (TFCC).

Patients typically experience pain on the little finger side of the wrist, especially during gripping, twisting or weight-bearing activities.

The condition may develop gradually or following an injury. In some cases, it is related to the natural shape or length of the ulna.

Treatment is focused on reducing pain, improving function and addressing the underlying cause.

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Diagnosis is based on clinical assessment and imaging.

Investigations may include:

• X-rays to assess bone alignment and ulnar length
• MRI scan to assess soft tissue structures such as the TFCC
• Wrist arthroscopy in selected cases

These help confirm the diagnosis and guide treatment planning.

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Treatment depends on the severity of symptoms and the underlying cause.

Non-surgical treatment may include:

• Activity modification
• Wrist splinting
• Anti-inflammatory medication where appropriate
• Hand therapy

If symptoms persist, surgical treatment may be considered. Options may include:

• Arthroscopy to assess and treat damage within the wrist
• Procedures to reduce pressure across the joint, such as shortening of the ulna

The aim of treatment is to relieve pain and restore function.

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Surgical treatment depends on the underlying cause and severity.

Procedures may include wrist arthroscopy to treat damaged tissue or an ulnar shortening procedure to reduce pressure across the joint.

These procedures aim to relieve pain and improve wrist function.

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Recovery depends on the type of treatment performed.

Recovery typically includes:

• A period of immobilisation
• Gradual return to movement and strengthening exercises
• Hand therapy where needed

Full recovery may take several weeks to months depending on the procedure.

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As with any surgical procedure, there are potential risks, although these are uncommon.

Possible complications include:

• Infection (around 1%), usually treated with antibiotics
• Swelling or stiffness, which may take time to settle
• Scar sensitivity
• Nerve irritation or injury (rare)
• Ongoing pain or incomplete relief of symptoms
• Reduced range of wrist movement
• Delayed healing of bone if a shortening procedure is performed

Very rarely, a condition known as complex regional pain syndrome (CRPS) can occur, leading to prolonged pain and sensitivity.

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You should seek medical advice if you have persistent pain on the little finger side of your wrist, particularly if it is affecting your grip or daily activities.

Early assessment can help identify the cause and guide appropriate treatment.

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