Definition
Degenerative condition caused by excess load across the ulnocarpal joint, with progressive wear of the TFCC, lunate and triquetrum.
Aetiology
- Positive ulnar variance, congenital or acquired
- Distal radius malunion with radial shortening
- Essex-Lopresti injury or radial head excision
- Dynamic positive variance with grip and pronation
Pathology
- Palmer Class 2 degenerative TFCC lesions, 2A to 2E
- Chondromalacia of the ulnar lunate, triquetrum and ulnar head
- Lunotriquetral ligament tear in later stages
Clinical Features
- Insidious ulnar wrist pain, worse with grip, pronation and ulnar deviation
- Positive ulnocarpal stress test
- Swelling and reduced forearm rotation
Investigations
- Neutral rotation PA radiograph to measure ulnar variance
- Pronated grip view to show dynamic variance
- Subchondral sclerosis or cysts in the ulnar lunate
- MRI shows lunate oedema before radiographic change
Differential Diagnosis
- Ulnar impingement syndrome, with a short ulna contacting the radius
- TFCC tears
- ECU subluxation
- Lunotriquetral instability
- Kienbock’s disease
Management
- Non-operative care. Activity modification, splinting and corticosteroid injection
- Wafer procedure. Open or arthroscopic resection of the distal ulnar dome for variance up to 4 mm
- Ulnar shortening osteotomy. Larger variance or lunotriquetral instability, tightening the ulnocarpal ligaments
- Distal radius corrective osteotomy. Impaction from radius malunion
- Combined DRUJ procedure. Matched resection or Sauve-Kapandji with coexisting DRUJ arthritis, see DRUJ Instability
Complications
- Nonunion and symptomatic plate after shortening osteotomy
- DRUJ arthritis from incongruity after shortening
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 19 October 2026.