Summary Ulnocarpal Abutment Syndrome is a common source of ulnar sided wrist pain secondary to excessive impact stress between the ulna and the carpal bones (primarily lunate). Diagnosis is made with PA wrist radiographs showing positive ulnar variance and sclerosis of the lunate. Treatment includes a trial of rest and splinting for minimally symptomatic patients. Operative ulnar shortening procedures are indicated depending on severity of symptoms. Etiology Pathoanatomy in a wrist with +2 mm ulnar variance approximately login to view 2 more bullets in a normal neutral wrist approximately login to view 2 more bullets Associated conditions positive ulnar variance can be seen in the setting of: login to view 4 more bullets Presentation Symptoms pain on dorsal side of DRUJ increased pain with ulnar deviation of wrist pain with axial loading ulna sided wrist pain Physical exam Ballottement test login to view 2 more bullets Nakamura's ulnar stress test login to view 2 more bullets fovea test login to view 2 more bullets Imaging Radiographs recommended views login to view 5 more bullets findings login to view 2 more bullets MRI evaluate for TFCC tears which may be caused by ulnocarpal impingement and often influences treatment Differential Ulnar styloid impaction syndrome DRUJ instability or arthritis TFCC tear LT ligament tear pisotriquetral arthritis ECU tendonitis or instability Lunotriquetral coalition Treatment Nonoperative supportive measures login to view 2 more bullets Operative ulnar shortening osteotomy login to view 3 more bullets Wafer procedure login to view 5 more bullets Darrach procedure (ulnar head resection) login to view 4 more bullets Sauvé-Kapandji procedure login to view 4 more bullets ulnar hemiresection arthroplasty login to view 3 more bullets ulnar head replacement login to view 5 more bullets Techniques Ulnar shortening osteotomy approach login to view 1 more bullet technique login to view 1 more bullet