Ulnar Shortening Surgery: What You Need to Know

Wrist pain can be excruciating making simple chores nearly impossible.  A surgery commonly performed to address wrist pain is ulnar shortening surgery, but what exactly is ulnar shortening surgery?  What is an ulnar osteotomy?  What causes ulnar impaction syndrome?  What are the complications of ulnar shortening surgery?   Let’s dig in.

What Is an Ulnar Osteotomy?

Ulnar shortening surgery also known as ulnar osteotomy is a surgery where a section of the ulna bone is cut out in order to shorten the length of the ulna bone.  The ulna is one of two bones in the forearm.  It is the smaller of the two and located on the pinky side (ulnar) of your forearm.  The surgery is recommended for those patients who have ulnar (outside) wrist pain and injury that is not responsive to conservative therapy (1).  The rationale is that by shortening the length of the ulna bone you reduce the pressure and therefore the pain in the wrist.  Pain and injury in the outside aspect of the wrist thought to be due to excessive ulnar bone length is referred to as ulnar impaction syndrome (2).

What Causes Ulnar Impaction Syndrome?

Ulnar impaction syndrome is a degenerative condition that affects the small bones in the wrist along with the TFCC.  The ulnar bone is in contact with both structures.  The increased stress from ulnar bone can cause degeneration of the TFCC, small bones in the wrist and supporting ligaments.  A pre-disposing factor for ulnar impaction syndrome is increased ulnar length relative to the radius which is called ulnar variance (3).  Common symptoms are pain, swelling and reduced range of motion.  Symptoms are commonly aggravated by forceful grip and cocking the wrist outwardly (4).  The TFCC is a complex of ligaments and a meniscus like spacer on the ulnar side of the wrist that allows you to effectively use your thumb. It is a vital structure.

What Are the Complications?

When conservative care fails, ulnar shortening surgery is recommended (5)  In the operating room, the ulnar bone is shortened by cutting out a portion of the bone.  The ulna then stabilized with a steel plate and screws. Complications include (6):

• Irritation of hardware (51%)
• Failure of the bone to heal (8%)
• Refracture of the ulna (11.4%)
• Chronic regional pain syndrome (6.7%)
• Revision surgery (13.3%)
• Removal of hardware due to pain (45%)

There is no high-level evidence to support this surgery.

Nonsurgical Treatment Options?

At the Centeno-Schultz Clinic, we have extensive experience in the treatment of TFCC tears and wrist pain. Common causes of wrist pain include loose wrist ligaments, aggravated tendons, ulnar nerve irritation or compression or irritation of the nerves in the neck.  PRP and bone marrow-derived stem cells are precisely injected under ultrasound guidance.  This is an advanced procedure that your local family doctor or orthopedic surgeon can not perform.  To watch a Centeno-Schultz Clinic ultrasound-guided injection of PRP into the hand and median nerve please click on the video below.

In Conclusion

Ulnar shortening surgery, also known as ulnar osteotomy, is cutting out a portion of the ulna bone which is thought to be causing excessive force, injury, and pain in the wrist.  The surgery is recommended if conservative treatment fails.  The surgery is associated with significant risks which include failed bone healing, fracture, irritation of metal plate requiring the removal and chronic pain syndrome.  There is no high-level evidence to support this aggressive surgery.   Evaluation and treatment of wrist ligaments, nerves, and tendons with precise injections of PRP or stem cell is a viable alternative to an overly aggressive surgery that is not supported in the literature and full of complications.

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1.Watanabe A, Souza F, Vezeridis PS, Blazar P, Yoshioka H. Ulnar-sided wrist pain. II. Clinical imaging and treatment. Skeletal Radiol. 2010;39(9):837-57.DOI: 10.1007/s00256-009-0842-3.

2.Friedman SL, Palmer AK. The ulnar impaction syndrome. Hand Clin. 1991;7(2):295-310.

3.Jalan D, Elhence A, Yadav P. Measurement of Ulnar Variance in a Regional Subset of Indian Population-A Pilot Study of 30 Subjects. J Clin Diagn Res. 2015;9(9):RC05-8. Jalan D, Elhence A, Yadav P. Measurement of Ulnar Variance in a Regional Subset of Indian Population-A Pilot Study of 30 Subjects. J Clin Diagn Res. 2015;9(9):RC05-8.

4.Sammer DM, Rizzo M. Ulnar impaction. Hand Clin. 2010;26(4):549-57.DOI: 10.1016/j.hcl.2010.05.011.

5. Watanabe A, Souza F, Vezeridis PS, Blazar P, Yoshioka H. Ulnar-sided wrist pain. II. Clinical imaging and treatment. Skeletal Radiol. 2010;39(9):837-57. DOI: 10.1007/s00256-009-0842-3.

6. Rajgopal R, Roth J, King G, Faber K, Grewal R. Outcomes and complications of ulnar shortening osteotomy: an institutional review. Hand (N Y). 2015;10(3):535-40. doi: 10.1007/s11552-014-9727-6.