What’s the deal with my pinky side wrist pain?
There are lots of different ways that wrist function can go sideways, but if you’ve ever experienced ulnar sided wrist pain that onset from a sporting injury…. Well, woweee… you know what a unique doozy of a pain it can be!
What is it?
The ulnar fovea is an anatomic region at the base of the pinky side (ulnar side) of the wrist. It’s just filled with lovely little sensitive structures -cartilage, tendons, ligaments and the like- that proved a load bearing and force transfer functions.
These structures are both numerous and difficult to individually test in a clinical exam so it can be tough to figure out which one of them is causing the problem in the case of injury. For this reason the Ulnar Fovea is sometimes referred to as an “anatomical black box”, in reference to the difficulty knowing exactly which of them is damaged!
Structures in the ulnar Fovea are susceptible to injury from sports that require lots of wrist rotation, wrist flicking (backhand/forehand type movements), or load bearing through the wrist. Think tennis (or any racquet sport really), golf, and rugby amongst many others.
Injury to one of the structures of the ulnar fovea can be quite acutely painful! If you have an issue in this area you’ll know it. Injury here is characterised by a point tenderness over the ulnar side of the wrist that feels like a very distinct point tenderness over the soft area just underneath the end of the ulna (see Fig 2).
Generally speaking – Ulnar Fovea pain corresponds to one of 3 injury types:
Extensor carpi ulnaris (ECU) tendon strain: The ECU is a forearm muscle that acts to extend the wrist, think one of the muscles that helps you to flick a backhand.
As with many tendons, low level injury often results from repetitive strain, as occurs when taking up a new activity or increasing the amount of participation in a new activity. Occasionally though there is a traumatic event – a heavy serve reaching scooping action with a racquet/stick that can tear the structure. Putting it simply, if you are pumping up the jam in your sport you are at risk (especially if you are playing racquet sports).
These injuries vary in flavor intensity. Some ECU injuries are low grade tendon irritations (less serious) and others involve frank tearing away of the tendon sheath (more serious!) from the ulna bone.
Triangular Fibrocartilage Complex (TFCC) or Distal Radioulnar Joint (DRUJ) tear: The TFCC is a hunk of cartilage and some associated ligaments that occupy a lot of space in the ulnar fovea. It’s a neat soft tissue structure in that it forms a sort of hammock that supports up to 20 percent of the load across the wrist. You’ll notice in Fig 2 below that that ulnar side of the wrist has a big gap where no bony attachment is found. This is the space occupied and supported by the TFCC.
This structure can be damaged with activities that induce a forceful end of range twisting of the wrist to palm up or palm down positions as may be experienced in many racquet sports, or through forceful loading through the ulnar side of the wrist as can be experienced in many sports (not to mention any garden variety slip and fall on an icy sidewalk)
Fig 2 – the gap at the ulnar side of the wrist. The TFCC is a group of soft tissue structures that sits in there and supports up to 20% of load across the wrist (see it in Fig 1).
This injury type can be tricky because some tears will heal on their own and some will not. The quality of healing depends on how well supplied with blood vessels the damaged tissue is, with damage more toward ulnar side healing better and damage closer to the centerline (radial side) of the wrist healing poorly.
The Distal Radioulnar Joint (DRUJ) is the joint between the 2 forearm bones, the radius and ulna, at the wrist. Look at figure 2 above. You can see this junction between the radius on the thumb side and the ulna on the pinky side. Notice how this joint forms part of the border of the “gap” which is filled in by the structures of the TFCC. This relationship means that DRUJ disruption goes hand in hand with TFCC tearing, in that ligaments important to stabilising the DRUJ are considered part of the group of anatomic structures making up the TFCC.
One way to to help you appreciate if damage to the ligaments supporrting this joint are part of your issue is by conducting a test known as the Piano Key Sign. First, push both arms straight out in front of you in a punching type position and hold them there. Look at the ulnar styloids at the wrist. These are those bumps toward the outside of the wrist – they are the bony prominences at the end of the ulna.
In cases where there is tearing of the DRUJ supporting ligaments, there may be an asymmetry left versus right with the affected side appearing more prominent. Placing the affected side palm down on a flat surface and pushing down in that prominent ulna bone a couple of inches up the forearm will also likely recreate pain.
Fig 1 – The anatomical “Black Box”, these structures and more populate the ulnar fovea. Imaging produced with help from the Essential Anatomy 3 App.
What should we do about it?
With almost all cases of ulnar wrist pain the first line treatment is the same. A period of immobilisation sometimes with the help of tape or a brace for a few (up to 6) weeks. Activity modification, like the kind that has you NOT do the aggravating action over that same period of time. Additionally, sometimes the use of anti-inflammatory medication is useful, although this is something that can be discussed with your physician.
In the case of ECU tendinopathy, as with any tendon problem at the wrist or elsewhere in the body a progressive strength training protocol will be part of the rehab package.
Occasionally, conservative treatments such as those described above do not result in satisfactory improvement. There are more invasive medical interventions, including surgery or on occasion steroid injections that are used to address stubborn cases that the body cannot heal on its own.
The takehome message here though is that ulnar sided wrist problems are common and in most cases fixable with some simple, conservative treatments. So take heart if this is you, your outlook should be positive! And if you have questions, do not hesitate to ask your therapist, that is what we are here for.
Further reading (if you really want to impress your friends)
Gil, J. A., & Kakar, S. (2019). Hand and Wrist Injuries in Tennis Players. Current reviews in musculoskeletal medicine, 1-11.
Pang, E. Q., & Yao, J. (2017). Ulnar-sided wrist pain in the athlete (TFCC/DRUJ/ECU). Current reviews in musculoskeletal medicine, 10(1), 53-61.
Henderson, C. J., & Kobayashi, K. M. (2016). Ulnar-sided wrist pain in the athlete. Orthopedic Clinics, 47(4), 789-798.
Tagliafico, L. S. (2009) Wrist injuries in nonprofessional tennis players: relationships with different grips. American Journal of Sports Medicine. 37(4), 760-767
Yamabe, E., Nakamura, T., Pham, P., & Yoshioka, H. (2012). The Athlete’s Wrist: Ulnar-Sided Pain. Seminars in Musculoskeletal Radiology, 16(04), 331–337.
Overuse. Damaged tendons and ligaments due to repeated hand and arm motions or injuries. Triangular fibrocartilage complex (TFCC) injury. Tears or fraying in the tissues that connect the ulna to other parts of the wrist, often from a fall onto the wrist, or multiple repetitive twisting injuries.Should you see a physio about wrist pain? ›
The good news is that most wrist pain and injury respond favourably to physiotherapy or other medical intervention. Please do not delay consulting your healthcare practitioner if you experience wrist pain. Some wrist conditions do require surgery, so early assessment and intervention are important.What is the fastest way to heal ulnar wrist pain? ›
- Adjust how you work or type.
- Use ergonomic and padded tools.
- Avoid activities that aggravate your symptoms.
- Avoid resting your elbow on furniture or armrests. ...
- Apply ice to the area.
- Wear a wrist brace or splint.
- Take OTC pain relievers or anti-inflammatory medications.
Carpal tunnel syndrome symptoms usually start gradually and include: Tingling or numbness. You may notice tingling and numbness in the fingers or hand. Usually the thumb and index, middle or ring fingers are affected, but not the little finger.What nerve runs to your pinky? ›
The ulnar nerve transmits electrical signals to muscles in the forearm and hand. The ulnar nerve is also responsible for sensation in the fourth and fifth fingers (ring and little fingers) of the hand, part of the palm and the underside of the forearm.What is pinky side of wrist called? ›
The ulnar side of your wrist is the side of your “pinkie” finger (or small finger), and pain on this side can be very common. It's so common, in fact, that it can sometimes be difficult to determine the exact cause.What does tendonitis feel like in the wrist? ›
Symptoms of wrist tendinitis may include: Difficulty performing certain movements, such as opening jars or turning doorknobs, or lifting pets, babies or small children. Stiffness, “catching” or a popping sensation when moving your wrist or fingers. Swelling around your wrist or the bases of your fingers.Where should I massage if my wrist hurts? ›
Turn the arm so the palm is facing up. The point is 3 finger-widths from the wrist crease, in the hollow between the two tendons. Directions: Using thumb or fingers, apply firm pressure on the point. Use deep stroking motions from the point toward the palm.Should I stretch my wrist if it hurts? ›
Stretches are recommended as a preventive measure or to ease slight pain. However, they should not be used by people with inflammation or serious joint damage unless recommended by a healthcare professional. This is because, in those cases, exercise could cause more harm to your wrists or hands.Should you massage a strained wrist? ›
Chronic Stage – Wrist Sprain
However, massage can indirectly help a ligamentous sprain by improving the ability of a muscle to contract and stabilize the region by removing pain and dysfunction due to tightness and myofascial trigger points.
Arm and Hand Massage Techniques
In addition to stretching, massage therapy is an effective way to ease wrist pain, hand pain and carpal tunnel syndrome.
Wrist sprains usually take from 2 to 10 weeks to heal, but some take longer. Usually, the more pain you have, the more severe your wrist sprain is and the longer it will take to heal. You can heal faster and regain strength in your wrist with good home treatment.How do I know if my wrist pain is serious? ›
See a GP if:
pain in your wrist is stopping you doing normal activities. the pain is getting worse or keeps coming back. the pain has not improved after treating it at home for 2 weeks. you have any tingling or loss of sensation in your hand or wrist.
- Stage 1 (Mild) ...
- Stage 2 (Moderate) ...
- Stage 3 (Severe) ...
- Other nerve compression syndromes.
- Start with your arm extended straight and your palm up.
- Curl your fingers inward.
- Bend your elbow, bringing your curled fist up toward your shoulder.
- Return to your starting position.
- Repeat the exercise 3 to 5 times, 2 to 3 times a day.
What are the symptoms of carpal tunnel syndrome? Symptoms usually start gradually, with frequent numbness or tingling in the fingers, especially the thumb and the index and middle fingers. Some people with CTS say their fingers feel useless and swollen, even though little or no swelling is apparent.How do you know if you have nerve damage in your pinky? ›
Abnormal sensations in the little finger and part of the ring finger, usually on the palm side. Weakness, loss of coordination of the fingers. Claw-like deformity of the hand and wrist. Pain, numbness, decreased sensation, tingling, or burning sensation in the areas controlled by the nerve.What does a damaged ulnar nerve feel like? ›
Numbness and tingling in the ring finger and little finger are common symptoms of ulnar nerve entrapment. Often, these symptoms come and go. They happen more often when the elbow is bent, such as when driving or holding the phone. Some people wake up at night because their fingers are numb.Can Massage Help ulnar nerve entrapment? ›
Because the flexor carpi ulnaris is the primary problem, techniques that reduce tension in the flexor muscles of the forearm are most important. Be cautious when performing any massage techniques over the tunnel so that further ulnar nerve compression (aggravation of symptoms) does not occur.Will ulnar nerve heal itself? ›
Mild cases of ulnar nerve entrapment may resolve spontaneously without treatment. In some cases, pain and inflammation can be treated with medications such as nonsteroidal anti inflammatory drugs (NSAIDs).
Ulnar nerve entrapment in your elbow or wrist that's severe can cause muscle loss in your hand. This damage may be permanent in some cases, which is why it's important to see your healthcare provider early about symptoms.How do you test for ulnar nerve damage? ›
- X-ray. If you have limited elbow motion, an X-ray may be used to exclude other causes of elbow pain, such as arthritis, recent trauma, or past injuries.
- MRI Scan. Your doctor may order an MRI to better view the ulnar nerve. ...
- Ultrasound. ...
- Electromyogram. ...
- Nerve Conduction Study.
- pain and tenderness in the affected tendon, which is often worse when you move it.
- a grating sensation as the tendon moves.
- a lump on the tendon.
- weakness in the affected area.
- decreased range of motion.
Summary. The bottom line is that if you have tendonitis of the wrist, you should always wear a wrist brace while you sleep. During the day, wear it sparingly - if at all. And if you do, wear it only when doing heavy lifting.What are three symptoms of tendonitis? ›
- pain in a tendon that gets worse when you move.
- difficulty moving the joint.
- feeling a grating or crackling sensation when you move the tendon.
- swelling, sometimes with heat or redness.
- Do 8 repetitions.
- Rest for a minute.
- Repeat another set of 8 repetitions.
- Repeat this 2 to 3 times a day.
One of the easiest ways to begin improving your wrist strength is to squeeze a tennis ball. Purchase new or slightly used tennis balls and place one in the palm of each hand. Squeeze each ball as hard as you can. If you feel any pain in your wrist or fingers while squeezing, decrease the pressure.Is there a pressure point in your wrist? ›
The heart 7 pressure point can be found in the crease of your wrist. It lies in line with the space between your ring and pinkie finger. There's a bone directly in line next to this pressure point.What exercises can I do to fix wrist pain? ›
Wrist extensor stretch
Extend the arm with the affected wrist in front of you and point your fingers toward the floor. With your other hand, gently bend your wrist farther until you feel a mild to moderate stretch in your forearm. Hold the stretch for at least 15 to 30 seconds. Repeat 2 to 4 times.
Heat may be more helpful for chronic tendon pain, often called tendinopathy or tendinosis. Heat can increase blood flow, which may help promote healing of the tendon. Heat also relaxes muscles, which can relieve pain.
Pain. Swelling. Tenderness and warmth around the injury. Feeling a popping or tearing in the wrist.Can you permanently strain your wrist? ›
If a hand, elbow or wrist sprain is left untreated, you could experience: Increased pain. Chronic pain, or arthritis. Permanent damage to the muscle, tendon or ligament.Is heat good for strained wrist? ›
Do not use heat to relieve symptoms of a sprained wrist. Heat will increase blood flow to the area and will thereby cause or increase swelling. The symptoms associated with a mild wrist sprain will begin to lessen within three days; a moderate sprain will take longer.How should I sleep with ulnar wrist pain? ›
When sleeping on your side, place a pillow in front of you to support the whole arm, limit elbow flexion, and keep the wrist and fingers flat, in a neutral position. Consider sleeping on your back with your arms at your sides or on pillows to keep your elbows and wrists in an ideal position.What happens if ulnar nerve is left untreated? ›
If left untreated this condition could escalate to muscle weakness and permanent injury to the arm or hand. Ulnar nerve entrapment can be caused by: Leaning on your elbow for long periods of time.Will my wrist pain ever go away? ›
Most cases of hand and wrist pain will not be a sign of a serious or long-term problem and will settle in a few days or weeks with some simple self-care you can do at home. There are several conditions that can cause pain or other symptoms in the hands and wrists, including types of arthritis.Can you break your wrist without knowing? ›
Sometimes a bone can break without you realizing it. That's usually what happens to the scaphoid bone in your wrist, a boat-shaped bone located on the outermost side of the thumb side of the hand.Why does the side of my wrist hurt when I touch it? ›
Wrist pain is often caused by sprains or fractures from sudden injuries. But wrist pain also can result from long-term problems, such as repetitive stress, arthritis and carpal tunnel syndrome. Because so many factors can lead to wrist pain, diagnosing the exact cause can be difficult.What is the pinky side of the wrist called? ›
The ulnar side of your wrist is the side of your “pinkie” finger (or small finger), and pain on this side can be very common.Does ulnar wrist pain go away on its own? ›
If you experience uncommon ulnar wrist pain that restricts your wrist movements and interferes with your daily activities, you should visit a doctor. Ulnar wrist pain does not heal on its own.
Stiffness, “catching” or a popping sensation when moving your wrist or fingers. Swelling around your wrist or the bases of your fingers. Wrist pain, especially along the side of the wrist near the thumb or pinkie finger.What does wrist tendonitis pain feel like? ›
Wrist tendonitis pain usually develops over a period of time and may be felt as a burning sensation, a sharp stabbing pain, or a constant dull ache. In some cases, the pain may extend up to the elbow or down to the fingers. Touching or gently pressing the affected tendon may also cause pain.Will a brace help ulnar wrist pain? ›
The nerve compression in ulnar tunnel syndrome can cause numbness or tingling in the hands or fingers. Surgery or wearing a wrist brace can often treat ulnar tunnel syndrome.How long does ulnar wrist pain take to heal? ›
Wrist sprains usually take from 2 to 10 weeks to heal, but some take longer. Usually, the more pain you have, the more severe your wrist sprain is and the longer it will take to heal. You can heal faster and regain strength in your wrist with good home treatment.How do you loosen the ulnar nerve? ›
Bend back your wrist on your affected arm, pointing your hand up toward the ceiling. With your other hand, gently bend your wrist farther until you feel a mild to moderate stretch in your forearm. Hold for at least 15 to 30 seconds. Repeat 2 to 4 times.How long does ulnar take to heal? ›
Nonoperative Treatments. A stable, simple and isolated fracture of the ulna (secondary to a direct blow) can be treated with a cast for about four to six weeks. Your doctor will closely follow your progress with X-rays to assure nondisplacement of the fracture and proper bone healing.