Wrist Pain on the Pinky Side: Triangular Fibrocartilage Complex Injury vs Extensor Carpi Ulnaris Tendinitis vs Ulnar Impaction Syndrome (How to Tell the Difference)

Pain on the ulnar side of the wrist (the side closest to the little finger) is a well-known diagnostic challenge because many small structures—cartilage, ligaments, tendons, and the distal radioulnar joint—sit tightly packed together. A careful history and systematic exam are essential, and imaging findings can be subtle. ^[1]

To make it simpler, this article focuses on three of the most common culprits that people confuse with one another:

• Triangular fibrocartilage complex injury (often called a triangular fibrocartilage complex tear)
• Extensor carpi ulnaris tendinitis (and related extensor carpi ulnaris tendon instability)
• Ulnar impaction syndrome (also called ulnocarpal abutment)

These three can overlap—and sometimes more than one exists at the same time—especially because ulnar impaction syndrome can contribute to degenerative changes in the triangular fibrocartilage complex. ^[9]

Before you think about special tests, pay attention to exactly where the pain is most intense:

• Pain in the “soft spot” just next to the ulnar head (near the groove between the ulnar styloid and the small pea-shaped bone called the pisiform) often points toward a triangular fibrocartilage complex injury. ^[3]
• Pain on the back (dorsal) ulnar side, right over a tendon that may feel sore, thick, or “snappy” with turning the forearm, often points toward extensor carpi ulnaris tendon problems. ^[5]
• Deep aching pain with loading, especially with ulnar deviation (bending the wrist toward the little finger) and gripping, can suggest ulnar impaction syndrome—particularly if X-rays show positive ulnar variance (the ulna is effectively “longer” than the radius at the wrist). ^[7]

The triangular fibrocartilage complex is a load-bearing structure on the ulnar side of the wrist that helps stabilize the ulnar wrist and the distal radioulnar joint. ^[3]

What goes wrong:

• A traumatic injury (fall on an outstretched hand, twisting, sudden load) or
• Degenerative wear (often associated with aging or positive ulnar variance) ^[3]

Classic symptoms: clicking or popping with rotation, pain on the ulnar side, reduced grip strength, weakness, and difficulty rotating the wrist/forearm. ^[2]

The extensor carpi ulnaris tendon runs along the dorsal ulnar wrist and is held in a groove by soft tissue restraints. Because forces are high in this region, the tendon and its sheath can become inflamed or unstable. ^[1]

What goes wrong:

• Tendinitis or tenosynovitis: inflammation of the tendon sheath often tied to repetitive wrist motion and loading ^[6]
• Tendon instability or subluxation: the tendon shifts out of position, often causing a snapping sensation, especially during forearm rotation. ^[5]

Typical clinical picture: Acute cases may have swelling and tenderness over the dorsal ulnar wrist; chronic cases may feature tendon snapping and a sense of wrist instability. ^[5]

Ulnar impaction syndrome is a degenerative condition caused by excessive loading between the ulnar head and the ulnar-sided carpal bones and soft tissues, often related to positive ulnar variance. ^[7]

What goes wrong: Repeated “abutment” (impact stress) leads to cartilage wear, degenerative changes, and pain with loading.^[7]

Key imaging clue: Diagnosis is commonly supported by wrist radiographs showing positive ulnar variance and changes such as sclerosis in the lunate.^[7]

Examples: turning a doorknob, using a screwdriver, opening tight jars.

• Triangular fibrocartilage complex injury often causes pain with rotation and may produce clicking/popping during rotation.^[2,3]
• Extensor carpi ulnaris tendon instability can also cause clicking—often more like a “snapping tendon” sensation during rotation that you can sometimes feel or even see. ^[5]

Examples: pushing up from a chair, doing a plank, lifting a heavy pan, gripping hard with the wrist bent toward the little finger.

• Triangular fibrocartilage complex injury is often worse with ulnar deviation and can be associated with a positive ulnar fovea tenderness finding. ^[8]
• Ulnar impaction syndrome is classically a “load + ulnar side” problem and is associated with excessive impact stress between the ulna and carpal bones. ^[7]

Examples: pushing, lifting with the wrist extended, racquet sports, repetitive typing with a bent wrist.

• Extensor carpi ulnaris tendinopathy commonly presents with ulnar-sided wrist pain and can worsen with wrist extension; localized swelling may be present. ^[6]

Self-check clue A: “The ulnar fovea tenderness spot”

Many clinicians look for point tenderness in the soft area just palmar to the extensor carpi ulnaris tendon—often discussed as an important clinical sign in suspected peripheral triangular fibrocartilage complex injury. ^[10]

If pressing there reproduces your exact pain, it supports a triangular fibrocartilage complex-related source, but nearby tendon tenderness can feel similar because structures are close together. ^[11]

Self-check clue B: “Snapping that feels like a moving cord”

If you can feel a tendon “snap” over the ulnar wrist during forearm rotation, that supports extensor carpi ulnaris tendon instability.^[5]

Self-check clue C: “Deep ache with repeated loading”

If your pain is a deep ache that predictably worsens with load-bearing tasks, and especially if you have known positive ulnar variance, ulnar impaction syndrome becomes more likely.^[7,12]

This is one of the most valuable “long-tail keyword” style clues because many people can remember the exact trigger.

Triangular fibrocartilage complex injury mechanisms

• Fall or sudden load
• Twisting injury
• Axial load with the wrist deviated toward the ulnar side

Triangular fibrocartilage complex injury often occurs when load is compressed on the triangular fibrocartilage complex while the wrist is in ulnar deviation. ^[3]

Extensor carpi ulnaris tendinitis mechanisms

• Repetitive wrist motion with sports or work tasks
• Repetitive supination-related stress and tendon subluxation can contribute to tendon sheath inflammation ^[5]

Ulnar impaction syndrome mechanisms

• Often gradual, related to wrist anatomy and repetitive loading
• Can be associated with positive ulnar variance and degenerative overload ^{[7, 12]}

A major frustration for patients is that wrist pain can be real even when the first imaging test looks “normal.”

X-rays

• Useful for fractures and for ulnar variance, which matters for ulnar impaction syndrome. ^[7]
• Triangular fibrocartilage complex injuries often do not show directly on X-ray, but X-rays help rule out bone problems. ^[2]

Magnetic resonance imaging

Magnetic resonance imaging is widely used to evaluate triangular fibrocartilage complex injuries and ulnar-sided wrist pain; for triangular fibrocartilage complex injury it is helpful as a preliminary tool, though wrist arthroscopy is considered the diagnostic gold standard in uncertain cases. ^[13]

Ultrasound

Ultrasound can be useful for evaluating extensor carpi ulnaris tendon pathology, including tendinopathy and instability, and it can visualize tendon displacement with provocative movement. ^[5]

This section is designed to help readers understand the “typical pathway” rather than self-treat blindly.

Many expert reviews emphasize a systematic assessment and then conservative management first, with targeted imaging and escalation if symptoms persist. ^[13]

Common first steps include:

• Activity modification (avoid painful loading and twisting temporarily)
• Wrist brace or splint
• Anti-inflammatory measures when appropriate
• Hand therapy or physical therapy focusing on wrist stabilization and gradual loading

Cleveland Clinic notes that minor triangular fibrocartilage complex tears can heal without treatment if symptoms are minimal; for symptomatic cases, options include anti-inflammatory medication, bracing, corticosteroid injections, and therapy, with surgery for more severe tears. ^[2]

Key clinical reality:

• Peripheral tears and injuries associated with distal radioulnar joint instability often need more careful evaluation than small central degenerative tears.
• Persistent mechanical symptoms (significant catching, persistent instability) are reasons clinicians consider specialist referral.

Extensor carpi ulnaris tendon problems span a range: tendon sheath inflammation, tendinopathy, partial rupture, and instability. Many can be visualized with ultrasound. ^[5]

Typical conservative plan often includes:

• Rest from provocative tasks (especially repetitive rotation and extension)
• Splinting, sometimes in a position that reduces tendon stress
• Progressive therapy program restoring tendon capacity and forearm control
• Careful use of injections (this is individualized and depends on diagnosis; repeated steroid injection into tendons can carry risk—discuss with a specialist) ^[5]

For true tendon subluxation with persistent snapping and functional limitation, surgical options may be considered. ^[5]

Orthobullets notes that treatment can include rest and splinting for minimally symptomatic patients, while operative ulnar shortening procedures may be indicated depending on severity. ^[7]

A key concept here: If the underlying issue is structural overload related to ulnar variance and degenerative impaction, treatment may need to address load mechanics, not just inflammation.

Seek urgent or prompt assessment if you have:

• Sudden severe pain after a fall with swelling or deformity (possible fracture)
• Fever, warmth, redness, or rapidly worsening swelling (possible infection or inflammatory flare)
• Numbness or tingling into the ring and little finger with weakness (possible nerve involvement)
• Persistent pain that repeatedly returns and limits daily function

Cleveland Clinic emphasizes not ignoring wrist pain that persists or recurs and affects routine activities. ^[14]

A recurring point in ulnar-sided wrist pain literature is that these problems are often misdiagnosed, and “all that hurts is not the triangular fibrocartilage complex.” ^[13]

Here are the biggest reasons confusion happens:

• Triangular fibrocartilage complex injury and ulnar impaction syndrome can coexist. Degenerative triangular fibrocartilage complex tears are often associated with ulnocarpal abutment or impaction patterns. ^[9]
• Extensor carpi ulnaris tenderness and triangular fibrocartilage complex tenderness are close together. Some clinical discussions highlight how difficult it can be to distinguish adjacent tenderness patterns.^[11]
• A click does not automatically mean “triangular fibrocartilage complex tear.” Tendon snapping can create clicking too.^[5]

Use this as a way to describe your symptoms accurately to a clinician.

Most consistent with triangular fibrocartilage complex injury

• Pain near the little finger side + clicking/popping with rotation ^[2]
• Point tenderness between the pisiform and the ulnar head ^[3]
• Symptoms after a fall, twist, or ulnar-deviation load ^[3]

Most consistent with extensor carpi ulnaris tendinitis or instability

• Dorsal ulnar tenderness and swelling; pain in athletes or repetitive-use settings ^[5]
• Snapping/clicking you can feel along a tendon during forearm rotation ^[5]
• Pain with wrist extension and overuse patterns ^[6]

Most consistent with ulnar impaction syndrome

• Deep ulnar-sided ache, worsened by load-bearing and ulnar deviation
• History of anatomy favoring overload (positive ulnar variance) or degenerative pattern on imaging ^[7]

“Can a triangular fibrocartilage complex tear heal on its own?”

Yes—minor tears may heal without treatment when symptoms are minimal, while symptomatic tears often benefit from bracing, therapy, and sometimes injections or surgery depending on severity. ^[2]

“Why does my wrist click when I rotate my forearm?”

Clicking with rotation can occur with triangular fibrocartilage complex injury ^[2] or with extensor carpi ulnaris tendon instability, where the tendon shifts and can be palpated or observed. ^[5]

“Is ulnar impaction syndrome the same as ulnar abutment?”

They’re commonly used as synonyms; many sources describe it as excessive impact stress between the ulna and carpal bones with positive ulnar variance as a common feature. ^[7]

If you remember only one thing, make it this: pinky-side wrist pain is a pattern-recognition problem. Location + trigger + mechanical symptoms (deep click versus tendon snap) often points your clinician toward the right diagnosis faster than any single test.

• Triangular fibrocartilage complex injury: deep ulnar pain, clicking with rotation, fovea-area tenderness; magnetic resonance imaging can help, arthroscopy is the gold standard in uncertain cases. ^{[2, 3, 13, 14]}
• Extensor carpi ulnaris tendinitis / instability: dorsal tendon pain, swelling, overuse pattern, snapping or clicking with rotation that can be felt or observed; ultrasound can be helpful. ^{[5, 6]}
• Ulnar impaction syndrome: deep aching pain with loading and ulnar deviation, often tied to positive ulnar variance and degenerative overload; X-ray findings can be key. ^[7]

References: