Relief for Ulnar-Sided Wrist Pain
Do you have persistent pain on the “pinky side” of your wrist? Does it hurt to turn a doorknob, do a push-up, or swing a golf club? You might be suffering from a condition where one of your forearm bones is slightly too long. At California Pacific Orthopaedics in San Francisco, our hand and wrist surgeons specialize in ulnar shortening osteotomy—a procedure designed to correct this imbalance and get you back to living pain-free.
Overview
Your forearm is made up of two long bones that sit side-by-side: the radius and the ulna. Ideally, these two bones should be the exact same length at the wrist joint. This allows your wrist to move smoothly and share the load evenly when you grip or push things.
However, some people are born with an ulna that is longer than the radius. This is called positive ulnar variance. In other cases, the radius may shorten after a previous wrist fracture heals incorrectly.
When the ulna is too long, it bumps into the small bones of the wrist (the carpal bones) and the cartilage cushion known as the TFCC (Triangular Fibrocartilage Complex). This constant “bumping” causes wear, tear, and chronic pain.
Ulnar Shortening Osteotomy is a surgical procedure to fix this. “Osteotomy” simply means “cutting the bone.” During this surgery, your doctor removes a very small slice of the ulna bone to shorten it. This levels out the wrist joint, stops the bone from smashing into the wrist, and relieves the pressure on the damaged cartilage.
Why Is This Procedure Done?
Doctors perform this surgery to treat a condition called Ulnar Impaction Syndrome (also known as Ulnar Abutment Syndrome).
Think of your wrist like a tire on a car. If the alignment is off, the tire wears down unevenly on one side. In your wrist, if the ulna is too long, it bears too much weight. Instead of the radius taking about 80% of the load and the ulna taking 20%, the ulna might take 40% or more. This extra pressure grinds down the cartilage and ligaments.
Your California Pacific Orthopaedics surgeon may recommend this procedure if:
- You have chronic wrist pain: specifically on the ulnar (pinky) side that hasn’t gone away with rest, splinting, or cortisone shots.
- You have a TFCC tear: The extra length of the bone is poking a hole in the cartilage cushion (TFCC). Repairing the tear won’t help if the bone is still too long—it will just tear again. Shortening the bone fixes the root cause.
- You have early arthritis: The constant rubbing has started to wear away the smooth cartilage surface of the wrist bones.
- Previous fractures: You broke your wrist in the past, and the radius healed shorter than it used to be, leaving the ulna “prominent” or sticking out.
What To Expect: Before the Procedure
Preparing for surgery can be nerve-wracking, but our team in San Francisco is here to guide you through every step.
Consultation and Imaging
First, you will meet with one of our hand and wrist specialists. They will:
- Examine your wrist: They will check for tenderness and perform stress tests to see what movements cause pain.
- Take X-rays: This is the most important step. We need to see exactly how much longer the ulna is compared to the radius.
- MRI Scan: An MRI helps us see the soft tissues. It confirms if the long bone has torn the TFCC cartilage.
Getting Ready
Once surgery is scheduled, you will receive specific instructions:
- Medical Clearance: Depending on your age and health, you may need a check-up with your primary care doctor to ensure you are safe for anesthesia.
- Medications: You may need to stop taking supplements or blood thinners (like aspirin or ibuprofen) for a week before surgery to prevent bleeding.
- Fasting: You will likely need to stop eating and drinking the night before the surgery.
- Arranging Help: You will not be able to drive yourself home, so you must arrange for a friend or family member to pick you up.
What To Expect: During the Procedure
This surgery is typically an outpatient procedure, meaning you go home the same day. It is performed in a surgery center or hospital in the Bay Area.
- Anesthesia: Most patients receive general anesthesia (you are asleep) or regional anesthesia (your arm is numb, and you are sedated). You will not feel pain.
- The Incision: The surgeon makes an incision (cut) along the inside edge of your forearm, usually about 3 to 4 inches long.
- Removing the Bone: Using precise instruments, the surgeon cuts out a specific slice of the ulna bone. The amount removed is tiny—usually only 2 to 3 millimeters (about the thickness of a nickel).
- Closing the Gap: The two ends of the bone are brought together.
- Fixation: To keep the bone in place while it heals, a sturdy metal plate and screws are attached to the bone. This hardware typically stays in your arm permanently and does not need to be removed unless it bothers you later.
- Closing Up: The incision is closed with stitches, and your arm is placed in a splint or heavy bandage.
The surgery usually takes about 60 to 90 minutes.
What To Expect: After the Procedure
Recovery takes time because you are waiting for a bone to heal (union).
The First Two Weeks
- Splinting: You will be in a bulky splint that goes from your hand up to your forearm. You must keep this dry.
- Pain Control: You will have some pain, which is normal. We will provide a prescription for pain relief, but many patients switch to Tylenol within a few days.
- Elevation: Keeping your hand raised above your heart is crucial to stop throbbing and reduce swelling.
Two Weeks to Six Weeks
- Cast or Removable Brace: At your first follow-up visit, your stitches will be removed. You will likely be switched to a removable wrist brace or a cast, depending on how the bone looks on X-ray.
- Therapy: You might start working with a Certified Hand Therapist. They will give you gentle exercises to keep your fingers and shoulder moving so they don’t get stiff. You will not be allowed to lift anything heavy yet.
Six Weeks and Beyond
- Bone Healing: We will take X-rays around the 6-week mark to see if the bone has knitted back together.
- Increasing Activity: Once the bone is healed, you can start strengthening exercises.
- Full Recovery: Most patients return to normal activities (like typing) within 6 to 8 weeks. Heavy lifting and sports (like golf or tennis) usually require 3 to 4 months of healing.
Risks and Complications
Ulnar shortening osteotomy is a safe and highly effective procedure, but all surgeries carry some risks.
- Non-union: This is when the bone fails to heal together. It is more common in smokers. If this happens, a bone stimulator or second surgery might be needed. We strongly advise stopping smoking before this surgery.
- Hardware Irritation: Because the ulna is close to the skin, some patients can feel the metal plate. If it becomes painful or annoying, it can be removed in a simple procedure after the bone has fully healed (usually a year later).
- Infection: As with any cut, there is a small risk of infection, which is treated with antibiotics.
Why Choose California Pacific Orthopaedics?
Your wrist is a complex machine of moving parts. Correcting the length of a bone by just a few millimeters requires precision and expertise.
Top-Tier Hand Specialists At California Pacific Orthopaedics, our team includes fellowship-trained hand surgeons who have performed countless ulnar shortening procedures. We understand the specific needs of San Francisco’s active population—whether you are a rock climber, a violinist, or a computer programmer.
Integrated Care We work closely with the best hand therapists in San Francisco to ensure your recovery is smooth. Surgery is just the first step; rehabilitation is where you get your function back.
Patient-Centered Approach We believe in explaining “the why” behind your pain. We will show you your X-rays, explain the mechanics of your wrist, and help you decide if surgery is the right choice for your lifestyle.
Is Wrist Pain Stopping You?
If you have pain on the pinky side of your wrist that just won’t quit, don’t live with it. Contact us today to schedule an evaluation with one of our San Francisco hand experts. Let’s get your wrist back in balance.
