The Unusual Suspects in Ulnar-Sided Wrist Pain: The Ulnar Styloid Impaction Spectrum

Abstract

Introduction

Ulnar styloid impaction lesions occur secondary to point-loading of the proximal triquetrum by an elongated styloid. This is an uncommon cause of ulnar-sided wrist pain and can be difficult to differentiate from ulnocarpal impaction syndrome. Radiological features are typically only present in advanced lesions resulting in large chondral defects of the triquetrum, thereby making diagnosis difficult.

Case Presentation

Three cases of patients with nonspecific mechanical ulnar-sided wrist pain and equivocal clinical and radiological findings are used to describe the spectrum of isolated ulnar styloid impaction lesions. The importance of a stepwise approach to wrist arthroscopy as part of the diagnostic workup, and the routine visualization of the pisotriquetral joint in helping identify this lesion is also discussed.

Discussion

Ulnar styloid impaction lesions should be considered in all patients presenting with ulnar-sided wrist pain. Proficiency in diagnostic wrist arthroscopy, with routine inspection of the pisotriquetral joint, is recommended in all patients to identify such lesions, which are commonly not visualized on preoperative imaging.

Conclusion

Diagnostic wrist arthroscopy plays a pivotal role in distinguishing between isolated ulnar styloid impaction lesions and other causes of ulnar-sided wrist pain, a distinction that is essential for guiding appropriate therapeutic management.

Keywords

wrist - ulnar-sided - styloid impaction - elongated ulnar styloid

Publication History

Received: 18 September 2025

Accepted: 18 December 2025

Article published online:
14 January 2026

• References

• 1 Garcia-Elias M. Dorsal fractures of the triquetrum-avulsion or compression fractures?. J Hand Surg Am 1987; 12 (02) 266-268
• 2 Cerezal L, del Piñal F, Abascal F, García-Valtuille R, Pereda T, Canga A. Imaging findings in ulnar-sided wrist impaction syndromes. Radiographics 2002; 22 (01) 105-121
• 3 Ahsan ZS, Rivlin M, Jupiter JB. Ulnar-sided wrist pain due to long ulnar styloid: a case report. J Wrist Surg 2016; 5 (04) 311-314
• 4 Jones Z, Ecker J. The wind off test (WOT): a novel clinical test for DRUJ instability. J Wrist Surg 2025;
• 5 Nakamura R, Horii E, Imaeda T, Nakao E, Kato H, Watanabe K. The ulnocarpal stress test in the diagnosis of ulnar-sided wrist pain. J Hand Surg [Br] 1997; 22 (06) 719-723
• 6 Ecker J, Pavleski K, Andrijich C. The hook test is not pathognomonic for foveal detachment of the triangular fibrocartilage. J Wrist Surg 2023; 13 (01) 44-48
• 7 Fontès D. [Pathology of the triangular fibrocartilaginous complex in distal radius fractures]. Hand Surg Rehabil 2016; 35S: S60-S68
• 8 Cerezal L, del Piñal F, Abascal F. MR imaging findings in ulnar-sided wrist impaction syndromes. Magn Reson Imaging Clin N Am 2004; 12 (02) 281-299 , vi
• 9 Zahiri H, Zahiri CA, Ravari FK. Ulnar styloid impingement syndrome. Int Orthop 2010; 34 (08) 1233-1237
• 10 Scarano KA, Owusu-Sarpong S, Mulligan MT. Bilateral ulnar styloid impaction syndrome treated with ulnar styloidectomy. J Wrist Surg 2019; 8 (03) 240-244
• 11 Tomaino MM, Gainer M, Towers JD. Carpal impaction with the ulnar styloid process: treatment with partial styloid resection. J Hand Surg [Br] 2001; 26 (03) 252-255
• 12 Jain DKA, Wahegaonkar AL. Ulnar-side wrist pain management guidelines: all that hurts is not the TFCC!. Indian J Orthop 2021; 55 (02) 310-317
• 13 Topper SM, Wood MB, Ruby LK. Ulnar styloid impaction syndrome. J Hand Surg Am 1997; 22 (04) 699-704
• 14 Bain GI, Munt J, Turner PC. New advances in wrist arthroscopy. Arthroscopy 2008; 24 (03) 355-367