CHAPTER 54 - Ulnar-Sided Wrist Pain

Abstract

Ulnar-sided wrist pain has often been equated with low back pain because of its insidious onset, vague and chronic nature, intermittent symptoms, and frustration that it induces in patients. Chronic ulnar-sided wrist pain may be accompanied by a history of Workers' Compensation claims and unrelenting and irresolvable pain, and it may occur in patients with difficult personalities. Despite these issues, many patients with ulnar-sided wrist pain do have pathologic lesions that may be amenable to surgical treatment. The anatomy of the ulnar side of the wrist is complex, with many overlapping areas that may be a cause of pain. A clear understanding of the normal anatomy of the ulnar side of the wrist in addition to a systematic evaluation with both physical examination and radiographic imaging can often elucidate the etiology, and thus the treatment, of ulnar-sided wrist pain. The differential diagnosis of ulnar-sided wrist pain can be divided into six elements: osseous, ligamentous, tendinous, vascular, neurologic, and miscellaneous. Osseous injuries include the sequelae of fractures (i.e., nonunion or malunion) and degenerative processes. Fracture nonunions of the hamate1-4, pisiform5-10, triquetrum11-13, base of the fifth metacarpal14-17, ulnar styloid process, and distal part of the ulna or radius have been reported to cause ulnar-sided wrist pain. Degenerative processes at the pisotriquetral joint18, midcarpal (triquetrohamate) articulation, fifth carpometacarpal joint14-17, or distal radioulnar joint can also result in substantial ulnar-sided wrist pain. Ulnar impaction or abutment into the radius or carpus has been reported as well19-21. Ligamentous injuries can occur in any of the ulnar-sided intrinsic (lunotriquetral or capitohamate) or extrinsic (ulnolunate, triquetrocapitate, or triquetrohamate) ligaments as well as the triangular fibrocartilage complex1,18,19 …