Ulnar-Sided Wrist Pain & Wrist Instability

Ulnar-sided wrist pain — pain on the little finger side of the wrist — is one of the more complex areas of hand and wrist surgery.

Many patients are initially told they have a “sprain” or “tendonitis”, but persistent wrist pain may involve subtle instability, ligament injury, cartilage damage, tendon pathology, altered wrist mechanics, or post-traumatic imbalance.

The wrist relies on multiple small bones and ligaments moving together in a highly coordinated way. Even relatively small injuries can significantly affect grip strength, load tolerance, rotation, and long-term function.

Common causes of ulnar-sided wrist pain include:

TFCC injuries
DRUJ instability
ECU tendon instability
Ulnar impaction syndrome
LT ligament injury
Occult instability
Post-traumatic degeneration
Tendon irritation
Inflammatory conditions

Symptoms may include:

Pain with gripping or twisting
Clicking or clunking
Weakness
Reduced load tolerance
Pain rotating the forearm
Difficulty with sport, tools, lifting, or push-ups

Careful assessment is extremely important. MRI findings alone are often insufficient, and some significant instability patterns may appear subtle on scans. Conversely, MRI abnormalities are common and do not always explain symptoms.

Treatment depends on the underlying pathology and may involve:

Splinting
Therapy
Injections
Activity modification
Arthroscopy
Ligament reconstruction
Tendon stabilisation
Corrective osteotomy
Partial reconstruction procedures

The aim is not simply pain reduction, but restoration of stable, reliable wrist mechanics and long-term function.

Why can wrist pain be difficult to diagnose?

The wrist is one of the most mechanically complex joints in the body. Multiple ligaments, tendons, cartilage structures, and small joints interact together during movement. Some instability patterns are dynamic, meaning they only become apparent under load or during specific movements, and may not always be obvious on static MRI scans.