Ulnocarpal Impingement and Triangular Fibrocartilage Complex Tears

Ulnocarpal impingement syndrome is a common reason for ulnar-sided wrist pain in athletes. Clinical history, imaging, and physical examination are important when diagnosing and formulating a management plan. Gymnasts and baseball and racket playing athletes are at higher risk for ulnocarpal (UC) impingement because of repetitive wrist pronation and gripping. Overloading of the UC joint can progress to ulnar head chondromalacia, triangular fibrocartilage complex tears, and lunotriquetral ligament damage. Treatment options for UC impingement range from rest and splinting to operative intervention. Splints that limit wrist pronation and supination prevent the ulna from being driven distally into the lunate. Ulnar shortening osteotomy remains the gold standard for UC joint unloading, but other interventions including arthroscopic debridement with the ulnar wafer procedure can be effective. Recovery time and complication rates vary between each operative procedure and should be taken into consideration when managing athletes.