Wrist Pain

One cause of ulna sided wrist pain is disruption or tear of the triangular fibrocartilage complex (TFCC). The TFCC lies between the ulna and the carpal bones. It is composed of an articular disc that absorbs compressive loads as well as the radioulnar and ulnocarpal ligaments and the extensor carpi ulnaris.

The TFCC can be injured in a fall, a rotational injury or in the older (above 50) patient who is involved in repetitive tasks particularly involving compression through an extended or ulna deviated wrist. Degenerative tears and perforations can occur. Chondromalacia can occur between the lunate and ulna head.

Examination may reveal tenderness and swelling over the dorsal ulna aspect of the wrist, reduced grip strength and pain with a combined movement of extension with ulna deviation. The press test may be positive. Ask the patient to lift their weight up off a chair. This creates an axial compressive load through the extended wrist, a positive test will reproduce the symptoms.

Ulna Variance
In pronation the ulna moves distally relative to the radius increasing the load that is transmitted to the distal ulna. This is positive ulna variance. Symptoms worse in pronation and grip strength that is decreased in pronation may indicate a compressive problem of the disc wheareas pain in supination may indicate a problem with the radioulnar or ulnocarpal ligaments.

The mainstay of physiotherapy treatment is splinting of the wrist to prevent extension and ulna deviation. The splint is worn for up to 6 weeks followed by strapping for potentially aggravating activities for a further 2 to 6 weeks. Education in avoiding compressive loads through an extended/ ulna deviated wrist and strong gripping is important. As pain improves exercises to restore ROM and isometrics for the wrist flexors/ extensors are given. Mobilisations of the carpal bones, if restricted mobility is found, can be helpful.

February 27th 2019

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