Ulnar Sided Wrist Pain: An Intro
On my Instagram, I just posted 1 out of 3 of a series on ulnar sided wrist pain, mostly for climbers, but I’m also talking about anyone with ulnar sided wrist pain who has gotten on the wrist widget train. And don’t get me wrong. I am a lover of the wrist widget over other braces for TFCC tears. But I have seen so many people on the ‘Gram giving advice on ulnar sided wrist pain and advising the wrist widget for anything that is painful on the pinky side of the wrist. I wanted to give the CHT’s perspective on this. And this is important because the wrist widget was made by a CHT.
So if you’ve been wearing the wrist widget and it’s not helping, here’s why:
The Wrist Widget is for TFCC injuries
The TFCC: Triangular Fibrocartilage Complex is made up many soft tissue structures and cartilage, the meniscus homologue acting as a trampoline to impacting forces on the wrist. Key things to note, simplified, are that the TFC complex does not have good blood supply, the central part of the disc getting even less blood flow than the periphery, the distal radial ulnar ligaments are the main stabilizers of the TFCC, and that when you have a TFCC injury, the main actions that are painful would be gripping and weight bearing.
The DRUJ (distal radioulnar joint) is where the forearm bones articulate, or move, about each other, and generally, they stay beautifully close together during rotational and weightbearing movements. When the TFCC is injured, the DRUJ is impacted where they are no longer kept compactly together. When we bear weight on our wrists, the radius (the larger-looking bone to the wrist) is supposed to take 80% of the load, where the ulna only really takes 20% and cushioned by the TFCC. If the complex or DRUJ become unstable, ouch. We don’t like it. That is why, if we wore the wrist widget during various healing phases of a TFCC injury, it acts as an external stabilizer (like the distal radioulnar ligaments) for the complex, allowing us to put more weight into our wrists and act as a great tool to continue to move with less pain.
Ulnar Sided Wrist Pain Differential Diagnoses
We can’t just jump to the conclusion that if we have ulnar sided wrist pain, we have a TFCC tear - degenerative or traumatic. Here are some differential diagnoses of what could be going on at that pinky side of the wrist:
Flexor Carpi Ulnaris tendinopathy
Extensor Carpi Ulnaris tendinopathy
Ulnar Impaction/Ulnar Abutment
Scapholunate Ligament tears
Hamate Fractures
Flexor Pollicis Longus involvement
The wrist widget was not made for these conditions, and there are actually different rehab programs or protocols for this. Last month, I had a climber come up to my table at a climbing event to grab my info for her partner, when I saw her wearing a wrist widget. I asked her why she was wearing it, and after a few quick screening tests, we found that she did not have symptoms consistent with a TFCC tear, but rather ECU tendinopathy, in which case, no wonder her wrist wasn’t getting better with it on. It was actually causing more swelling around the straps, which was making things worse and chronic. All goes to say, I’m glad I was there to guide her in the right direction.
Now, this doesn’t just apply to climbers. Other people that I have seen with ulnar sided wrist pain include golfers, people who have had distal radius fractures, cyclists, skiers. If you think about it, we allow our wrists into extreme repetitive ulnar deviation all the time. Imagine yourself picking up your laptop or picking up your laundry basket. What does your wrist look like? The thing is, just because you do those things doesn’t instantly mean you’re tearing up that TFCC.
Contact me for a free screening/assessment
Contact me here for questions about your wrist pain to get a real assessment by a certified hand therapist, and let’s guide you in the right direction to get back to what you love most.