Pain along the little finger (ulnar) side of the wrist has three major causes: 1) triangular fibrocartilage complex injuries, 2) lunotriquetrial ligament injuries, and 3) ulnar impaction syndrome. Any of these problems can also limit grip strength and hand function.
The surgeon treating any of these problems must understand the complex bony and ligamentous anatomy, circulation, and nerve supply when planning surgery. In this article, Dr. K. Sachar from Hand Surgery Associates of Denver, Colorado reviews the clinical and imaging diagnosis then discusses treatment for all three problems.
The patient’s history will help the surgeon decide if the injury is acute from trauma, chronic from overuse, or degenerative from the natural process of aging. Each of these causes is associated with specific symptoms referred to as the clinical presentation.
For example, a traumatic injury with a popping sound and visible deformity suggests joint dislocation. Pain that lasts a long time is often present with injuries to the ligaments that hold the bones together. Sometimes an old injury flares up with new activities or increased activity involving the wrist and hand.
The physical exam can offer helpful clues. The surgeon compares the painful wrist to the other uninured wrist. He or she will be looking for any differences in appearance, motion, stability, and/or strength. Swelling is more likely with bone fractures. Movements that cause or reproduce pain are called provocative maneuvers. Specific individual joints can be tested using these maneuvers.
There are other specific tests to guide the surgeon in making a diagnosis such as the Regan shuck test, Kleinman shear test, piano key test, and ulnocarpal stress test.
One last diagnostic tool available to the surgeon is the imaging study. This could include standard X-rays of the wrist, CT scans, or magnetic resonance arthrography (MRA). MRA involves injection of a dye into the joint(s) to look for any place where the dye leaks out (a sign of ligamentous tear). MRI, multidetector CT, and ultrasound are also available for some situations.
When the diagnosis has been made, then the surgeon chooses the best treatment for that problem. Conservative care with splinting to immobilize the wrist may be advised. Surgery (when needed) may be as simple as debridement (removing loose fragments or shaving off ragged edges). Or in more complex injuries, surgical reconstruction may be needed.
The author provides a detailed review of the surgical options for these three causes of ulnar-sided wrist pain. Advantages and limitations of each procedure are outlined. The most challenging cases have more than one type of injury present and may require more than one surgical approach. Arthroscopic surgery yields positive results for most patients.