Ulnocarpal Impaction Syndrome

Ulnocarpal impaction syndrome is a condition that results in wrist pain on the side of the little finger (ulnar side). This condition is caused by the forearm bone (ulna) and bones of the wrist pinching other tissues. This condition is more common in people who have an ulna that is longer than the other forearm bone (radius). The tissue that is damaged is the a meniscus-like cartilage (fibrocartilage). If left untreated, then the cartilage that lines the bone may:

  • Wear away.

  • Degenerate.

  • Tear.

  • Cause increased wrist pain.

SYMPTOMS

  • Pain and tenderness around the ulnar side of the wrist.

  • Pain that is worse when the wrist is bent toward the little finger side or with heavy activity, such as push-ups.

  • Occasionally, clicking of the wrist.

  • Uncommonly, swelling of the wrist.

  • Pain with gripping or grasping.

CAUSES

The most common cause is an ulna that is longer than the radius. This causes pinching of the triangular fibrocartiladge, and results in painful symptoms.

RISK INCREASES WITH:

  • Sports that require repetitive wrist and hand motion (rowing, tennis, hockey, golf, pole vault, or baseball).

  • Sports that cause forceful loading at the hand and wrist (gymnastics, shot put, weightlifting, or cycling).

  • Poor hand strength and flexibility.

  • Improper sports mechanics.

PREVENTION

  • Warm up and stretch properly before activity.

  • Maintain appropriate conditioning. This includes having:

  • Arm, forearm, and wrist flexibility.

  • Muscle strength and endurance.

  • Learn and use proper sports technique.

  • Functional braces may be effective in preventing injury, especially re-injury, by reducing forceful bending of the wrist toward the little finger side.

PROGNOSIS

This condition is usually curable if treated with nonsurgical treatment. However, surgery may be necessary. Surgery may mean that an athlete cannot return to athletic competition.

RELATED COMPLICATIONS

  • Frequent recurrence of symptoms and repeated injury, resulting in a chronic problem, especially if activity is resumed too soon after injury.

  • Prolonged healing time if activities are resumed too soon.

  • Injury to other structures of the wrist.

  • Arthritis of the wrist.

  • Wrist stiffness (loss of wrist motion).

  • Locking and clicking of the wrist.

  • Prolonged disability.

  • Inability to return to the same level of sports.

  • Risks of surgery, including infection, bleeding, injury to nerves, persistent pain, increased pain, catching or locking, and need for reoperation.

TREATMENT

Treatment initially involves ice and medicine to help reduce pain and inflammation. Activity modification is best to reduce the likelihood of recurrent symptoms. Your caregiver may recommend restricting wrist movement to help in the reduction of pain and inflammation. Strengthening exercise may be needed after restricting wrist movement. These exercises will help you regain strength and a full range of motion. These exercises may completed at home or with a therapist. You should return to sports gradually after symptoms resolve. If symptoms do not resolve with non-surgical treatment, then surgery may be necessary:

  • To shorten the ulna.

  • To repair the damaged fibrocartilage.

Typically sports can be played again 3 to 6 months after. However, some athletes may not be able to return to sport after surgery.

MEDICATION

  • If pain medicine is necessary, then nonsteroidal anti-inflammatory medicine, such as aspirin and ibuprofen, or other minor pain relievers, such as acetaminophen, are often recommended.

  • Do not take pain medicine for 7 days before surgery.

  • Prescription pain relievers may be prescribed. Use only as directed and only as much as you need.

COLD THERAPY

Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or massage the area with a piece of ice (ice massage).

SEEK MEDICAL CARE IF:

  • Symptoms get worse or do not improve in 4 to 6 weeks despite treatment.

  • You experience pain, numbness, or coldness in the hand.

  • A blue, gray, or dark color appears in the fingernails.

  • New, unexplained symptoms develop (drugs used in treatment may produce side effects).