Pain over the little finger side of the wrist (Ulnar sided wrist pain)
Pain over the little finger side of the wrist, also referred as “ulna sided wrist pain,” is a common presentation to the hand surgeon. The diagnosis is complex in view of several ligaments, tendons and carpal bones (small bones of the wrist) along the ulna side (little finger side) of the wrist. A systematic approach by the hand surgeon using special tests such as an MRI scan when needed will help the surgeon reach to a diagnosis. Some of the common causes of ulna sided wrist pain are:
1. Ulnocarpal abutment
2. TFCC tear
3. ECU tendonitis
4. Ulna styloid-carpal abutment
5. Pisotriquetral arthrosis
6. Distal radio ulnar joint arthritis
Occasionally, the hand surgeon performs an arthrogram (injection of dye into the joint and examination under X-ray) and invasive procedures such as arthroscopy (key hole surgery) to look inside the ulna side of the wrist to confirm the diagnosis. It is important to understand that the findings seen on the MRI scan do not always explain the precise cause of the ulna sided wrist pain. It is therefore important that patients do not come to any firm conclusions about their diagnosis merely by reading the MRI reports and seek advice of the hand surgeon when necessary.
Once the diagnosis is established, treatment for ulna sided wrist pain is tailored to the underlying diagnosis. A multi-disciplinary team approach involving the hand surgeon, hand therapist and radiologist (specialist who is qualified to give opinion on investigations such as X-rays and MRI scans) is essential for optimal results. As with most conditions options of non-surgical treatment should be exhausted prior to going down the route of surgery. Non-surgical treatment options include a custom made splint to offload the area of pain, targeted exercises, modification of activities and a trial of steroid injection.
Surgical options for ulna sided wrist pain depend on the underlying condition and can range from key hole procedures to open surgery. For example, in case of surgery for ulnocarpal abutment, surgery would include carefully breaking the ulna (one of the two forearm bones) with a saw, shaving off a sliver of bone and holding the two ends of the bone with a plate and few screws. The forearm would then be placed in a plaster for 4 to 6 weeks. On the other hand, in case of a tear in the TFCC (a cushion like structure separating the small bones of the wrist and the ulna), the patient would be offered keyhole surgery either to trim the TFCC or repair it with special suture material. This is less invasive than open surgery.