Longitudinal Split Tears of the Ulnotriquetral Ligament

A tear of the ulnotriquetral (UT) ligament can be a troubling source of pain for the athlete, especially those participating in racquet and batting sports. The UT ligament originates from the TFCC and ulnar styloid and is typically injured when an axial load is applied to an extended wrist with forearm supination. The diagnosis is based on physical exam, specifically the ulnar fovea sign. The stability of the distal radioulnar joint (DRUJ) differentiates a longitudinal split tear of the UT ligament from a TFCC foveal tear. The utility of radiographic imaging is primarily to rule out other causes of ulnar-sided wrist pain. Once a UT ligament tear has been suspected by history and examination, the diagnosis can be confirmed arthroscopically, and one or two sutures are typically sufficient for repair. Arthroscopic repair leads to excellent results with return to full athletic participation.