Ulnar Shortening—Avoid This Barbaric Procedure

by Chris Centeno, MD /

ulnar shortening

I have a rule when seeing patients. If they describe a past surgical procedure to me and I involuntarily say, “They did what to you?” that procedure is a candidate for my top 10 dumb surgeries list. One of those procedures that has always been right up there is ulnar shortening. Your wrist hurts? It must be because your ulna bone is too long, so let’s just lop a piece out of that—you won’t miss it! Thankfully, the medical research on the complications of this procedure is now catching up to my gut-check response.

What Is Ulnar Shortening?ulnar shortening

The procedure is actually called an ulnar shortening osteotomy. The belief is that the pinky side of the wrist (called the ulnar side) gets arthritis and accumulated damage because people are born with an ulna bone that’s too long. Hence surgeons go in and cut out a piece of the ulna bone to shorten it and hopefully take pressure off that side of the wrist. The tissue on the ulnar side that surgeons are most concerned with is the TFCC, so let’s learn more about that structure.

What Is the TFCC?

If there is one part of the body that’s responsible for our modern civilization and everything that separates us from the animal kingdom (other than our brain), it TFCC anatomywould be the triangular fibrocartilage complex (TFCC). This is a complex of ligaments and a meniscus-like spacer on the ulnar side of the hand that allows you to use your opposable thumbs. Given that thumbs that allow you to grasp and manipulate things require a big brain to run, the TFCC is the reason we learned how to make simple tools and eventually rocket ships.

When patients have TFCC damage, the ulnar side of the wrist hurts, and this gets worse with activity. There can also be swelling in the area. Finally, progressive wrist arthritis ensues, leading to pain and deformity.

For What Diagnosis Is Ulnar Shortening Surgery Performed?

This surgery is used to treat “ulnar impaction syndrome.” This simply means that there’s too much pressure on that side of the wrist due to a long ulna bone. This diagnosis is actually made by measuring angles on the wrist X-ray or MRI. There’s just one little problem with the diagnosis: it’s what I call a “squiggle of the wiggle and angle of the dangle” diagnosis.

Radiologists love to measure lengths and angles, because what else are you going to do sitting in a darkroom all day staring at a computer screen? They’re famous for observational studies that try to tie some angle measured on a picture of a patient with a musculoskeletal disease (like wrist arthritis). The problem is that this type of snapshot-in-time study can’t ever get to causality (e.g., the abnormal angle caused the arthritis). So the angle they’ve measured and the presence of the disease may well have little to do with one another.

The research studies that are written about these angles often drive surgical care—like adding gasoline to the surgical fire. It’s not long after one of these papers is published that orthopedic surgeons begin to figure out new and invasive ways to change the measured angle back to “normal.” That would be good if the new measured angle had anything to do with why the problem began, but it frequently turns out that it doesn’t, so a whole new world of unnecessary surgeries is born that are hard to later eliminate.

What Are the Complications?

This is where the big problems begin with ulnar shortening. The surgical research of the last few years has finally begun to realize all on its own that this is a dumb surgery. Let me explain.

As discussed, the surgeon is removing a piece of the ulna to try and reduce pressure on the wrist, but regrettably research using computer models has shown that if you change the relationship between the radius and ulnar bones, you actually put more negative forces on the wrist! Who knew? This has been bolstered by other studies reporting the occurrence of more arthritis due to alternations in wrist pressure caused by the surgery.

Complications are also huge, with several studies reporting that about half of all operated patients report irritation of the surrounding tissues by the plates that are used to heal the bone. Another recent study showed even worse outcomes, including delayed healing of the bone (13% of patients), nonhealing of the bone (8%), severe chronic nerve pain due to the surgery (7%), the need for revision surgery (13%), and the need to remove the hardware due to pain (45%)!  Bottom line, this surgery is a complications fest!

Is There Any Research Showing Ulnar Shortening Works?

Given all the serious complications of the procedure, you would think that this would be balanced by loads of research showing that the procedure was very effective in ending wrist pain. Regrettably, you would be wrong. We have no high-level research that shows this procedure is effective!

What Are the Alternatives?

If you have TFCC problems or wrist pain, we’ve used minimally invasive injections of orthobiologics, like platelets and stem cells, for years to help these tissues heal. In addition, in our experience, the wrist commonly hurts due to bad biomechanics that are usually centered in a neck problem. Here irritated neck nerves give bad signals to the forearm muscles, and all of this places too much pressure on the wrist. Alternatively, an old injury to the wrist ligaments causes instability, and this results in excessive motion of the wrist bones leading to wear-and-tear arthritis. In either case, fixing the bad movement patterns or precisely injecting your own platelets or stem cells into the TFCC, arthritic wrist joints, ligaments, or neck usually reduces pain and increases function without invasive surgery.

The upshot? Ulnar shortening is thankfully being exposed in the medical research as a dumb idea. This is consistent with the many patients I’ve seen through the years who have had this surgery and regretted making that decision. So stay away from surgeons who want to rearrange your anatomy—it’s probably just fine how it is!

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75 thoughts on “Ulnar Shortening—Avoid This Barbaric Procedure

  1. Bonnie Granahan

    I have wrist pain that seems to be coming from the base of my thumb.
    I was told by my Doctor that it is most likely Osteoarthritis.
    I also had an MRI that Neck Arthritis that is moderate and common for my age.
    What kind of treatment do you believe might help me resolve the pain in
    my wrist and base of thumb. They both feel less painful when I wear a splint
    but it would be nice to not have to rely on a splint all the time.

    1. Regenexx Team Post author

      Bonnie,
      This is a very common condition that we treat regularly with your own platelets and or stem cells. Please see: http://www.regenexx.com/hand-basal-joint-cmc-arthritis-treatment/ and http://www.regenexx.com/blog/texting-thumb-treatments/

    2. Letty

      I had shortening of the ulna. Was excruciatingly painful. I would never do it again. I think everything g on this report is true. Don’t do it! Have not have problems since 2012 that when I had surgery. Now I feel pressure.a lot . I’m thinking I going to go back to see the ortho, or should I leave it alone?

      1. Regenexx Team Post author

        Letty,

        So sorry to hear that. Your experience is not unlike many other patients we see as studies have shown that the procedure creates more force rather than relieving it. Please see:
        https://regenexx.com/blog/modern-orthopedic-surgery-for-pain/ and https://regenexx.com/blog/surgery-controlled-damage-accomplish-goal/ Unfortunately, we can’t advise without examining you.

        1. Mani Ebrahimi

          I agree with Letty
          I did the same surgery 4 months ago and I regret doing it.
          If you read my comment don’t do the surgery. Yhe cimplication and pain not only decreases it actually worsen.

  2. Steven Durrant

    I had an injury to my hand, a knife went in the webbed part of my hand I had stitches but I thought it would be OK after a while after it healed I’m having a burning and sometimes a stabbing feeling all over my index finger and my palm hurts and can feel where the cut was and the swollen tendon also like I’m having right now pain shooting up my a to my elbow what would be you option for treatment and where do I need to go I want to work on this going away so I can function at least kind of like I used to with my hand like being able to lift things and not having horrible pain even doing nothing I get pain I just don’t get it and want to fix it sooner then later.

    1. Regenexx Team Post author

      Steven,
      Addressing the situation is important as it sounds like it is escalating rather than remitting. Here is the list of Regenexx providers at which you can schedule an exam: http://www.regenexx.com/find-a-physician/

  3. Samantha Gibson

    I recently had the ulnar shortening surgery. I’ve started having intense muscle spasms and burning searing pain from elbow down. I have a congenital deformatity at the elbow on both sides due to my radius bone being longer than it should be. I have been going back to the doctor every 2 weeks since surgery and have been in a cast since one week after surgery. This is a work related accident and my 4th surgery. Should I be worried?

    1. Chris Centeno Post author

      Yes, this is something that you should discuss with your physician.

  4. Vicki

    “My anatomy is probably just fine as it is”?! I’ve been living with Ulnar Impaction Syndrome in both wrists for about 6 years now. The pain is intense and is exacerbated with any activity using my hands. While Cortisone injections help with the pain, they’re only temporary, limited to the number of doses I can get per year, and ultimately cause more damage to the tissues in my wrist. Shortening the Ulna bone is my only option to somewhat ease my symptoms. While the Osteotomy Shortening may not always be a success, at least it’s an option, rather than having to deal with the pain for the rest of my life.

    1. Regenexx Team Post author

      Vicki,
      The study you mentioned was a 2012 study. The ones included in the Blog are from 2015 and 2016, which is how these things often work. Someone comes up with the idea for some surgical intervention based on something seen on Xray or MRI, it becomes popular, then after the fact as complications are reported further studies are done which demonstrate that it wasn’t a good idea to begin with. Cutting things out and forever altering the body’s biomechanics has long term consequences. While some types of Orthopedic surgeries will be needed in some circumstances for the foreseeable future, tracking down and correcting the cause of problems is generally the better idea. (See http://www.regenexx.com/ulnar-shortening/ for common causes of this problem) We might not be able offer any help in your case, but if you’d like to inquire, please submit the Candidate form.

      1. Vicki

        I had the Ulnar Shortening surgery 3 months ago and it was a total success. I have zero pain from the Ulnar Impaction and needed no physical therapy. While I’m sure this procedure may not be appropriate for every kind of wrist/arm ailments, it IS necessary for severe Ulnar Impaction and I don’t believe it should be considered a ‘barbaric procedure’. Sometimes it’s necessary.

        1. Regenexx Team Post author

          Vicki,
          Very happy to hear the procedure worked for you! Importantly though, many of the issues from the surgery show up over time, so if and when they do, be sure to address them.

        2. Melissa

          I have had this done bilaterally for the same reason Vicki! It’s amazing to not be scared to move my arms for fear of locking up. The “barbaric” surgery was far less painful and complicated then having my joint stuck!

          1. Regenexx Team Post author

            Melissa,
            Really glad to hear it helped you! Both our clinical experience and the research have shown that if you change the relationship between the radius and ulnar bones, you actually put more negative forces on the wrist. That doesn’t mean it can’t help an individual patient, it means that out of large groups of patients, the outcome is a net negative.

          2. Codi

            My husband is having the Ulnar Shortening procedure done in 2 weeks. Please wish us the best of luck with the outcome. I would be interested in hearing both of your success stories with this procedure.

          3. Regenexx Team Post author

            Codi,
            While it’s not something we’d recommend unless all less invasive options were tried first, we wish your husband the very best of luck with the outcome!

        3. Janice Carroll

          I had my ulnar shortened in 2008. Took a little longer to heal, maybe because I use to be a smoker. Once it healed without any PT it has been pain free. Still have the plate and screws because they don’t seem to bother me and why have surgery for no good reason. At the time Dr also gave me a cortisone shot in my left wrist because it was also bothering me. It lasted 6 years. Might be because of some work I did that added a lot of strain on my left wrist. I am heading back to the Dr to see about another cortisone shot. maybe it will last for the rest of my days.

          1. Regenexx Team Post author

            Janice,
            The concern is that Cortisone shots break down cartilage. Alternatively, determining what’s causing the pain and treating it with an orthobiologic like PRP may help the problem rather than escalating it. Please see: https://regenexx.com/blog/cant-universities-take-lead-orthobiologics/ and https://regenexx.com/hand-basal-joint-cmc-arthritis-treatment/

    2. Lizz Beyer

      Does most insurance pay for your treatment options? If so, what would I “exactly ” tell my insurance company I’m wanting? I do a lot of physical labor with my hands and I am way too young to retire yet. The pain is unreal. I have No arthritis. I was considering this surgery when I ran can across your site. Please email as I may not find again, thanks .

      1. Regenexx Team Post author

        Lizz,

        Unfortunately, at this time, Medical Insurance does not cover stem cell procedures. That said, if everyone demanded coverage for sameday stem cell procedures for their specific issue, it might hasten the process.

  5. Lisa Nicholas

    I’ve had repairs to the TFCC in my right wrist twice after I tore the cartilage 4 years ago. The first procedure was a repair with a stitch in the cartilage, the second procedure used a screw to secure the cartilage to my ulna after the first repair failed. There is a strong possibility that the last repair has also failed due to a return of my symptoms, and my surgeon has advised I have Ulna shortening surgery as my last option. Would you agree?

    1. Regenexx Team Post author

      Lisa,
      There would be an exceedingly small set of circumstances in which we could recommend ulna shortening surgery. We’d be glad to take a look to see if we can help you avoid further surgery. If you’d like to do that, please submit the Candidate form. http://www.regenexx.com/hand-basal-joint-cmc-arthritis-treatment/

  6. Chris Dixon

    I had this surgery in August 2016 on my right wrist. Ulnar bone has rubbed all cartilage out of my wrist. After surgery I feel better than I have in fifteen years. No wrist pain! Now, knowing what my wrist should feel like, I could feel same ‘pinch’ in my left wrist. MRI confirmed same problem in my left wrist and I am having the same procedure in two weeks. Having ulnar osteotomy has completely changed my life (and my golf game) for the better! Surgery sucks…but my quality of life is better than ever.

    1. Regenexx Team Post author

      Chris,

      Really glad your happy with the results! The MRI findings that lead to the surgery and the non-surgical alternatives are specifically what the blog was about. Only you can decide if you’d prefer to try a few injections to avoid the longterm complications so common with the surgery, or not.

  7. Holly

    I have had arthroscopy done on my right wrist. I have had a peripheral tear that was not able to be stitched, but it was cleaned up giving me the trampoline effect. I had to go through therapy and eventually began to play tennis. My symptoms are somewhat back and an ulnar osteotomy was recommended before and as well as now. My fear is that I will not be able to continue playing tennis after this type of procedure. What would my best options be?

    1. Regenexx Team Post author

      Holly,
      Your concern is valid. We’ve used injections of platelets and stem cells for years to help these tissues heal. Your situation may be different as you’ve had arthroscopy which removes tissue without addressing the real problem, which tends to make the situation worse over time. Generally, in our experience, the wrist commonly hurts due to bad biomechanics that are usually centered in a neck problem. Here irritated neck nerves give bad signals to the forearm muscles, and all of this places too much pressure on the wrist. Alternatively, an old injury to the wrist ligaments causes instability, and this results in excessive motion of the wrist bones leading to wear-and-tear arthritis. In either case, fixing the bad movement patterns or precisely injecting your own platelets or stem cells into the TFCC, arthritic wrist joints, ligaments, or neck usually reduces pain and increases function without invasive surgery. If you’d like to see if we could help in your particular case, please submit the Candidate form: http://www.regenexx.com

  8. Loren Vanhorn

    I had surgery on my left ECU tendon about 2 years ago. Now the same symptoms are back and I can not turn my hand palm side up or lay flat. X-ray showed bone on bone contact between the ulnar and bones in the hand/wrist, and being told to have the bone shorting surgery. I had cortisone injection and now I can’t use my hand at all. Is the surgery my only option?

    1. Regenexx Team Post author

      Loren,
      First, Cortisone shots kill stem cells, breakdown cartilage, and injure tendons, therefore make the situation worse! Surgery isn’t necessarily the only option, but we’d need an MRI and a lot more information to offer an opinion. To do that, please submit the Candidate form. Here’s how we treat these types of issues: http://www.regenexx.com/hand-basal-joint-cmc-arthritis-treatment/

      1. Kay

        I agree about the cortisone shots. It did NOTHING for the pain (from a TFCC central tear and ulna impaction syndrome). In fact, things got worse afterwards. I definitely do not recommend cortisone shots.

  9. Amanda

    I had this surgery 9 years ago. After a bad fall during cheerleading they determined this was needed. Soooo big question I’ve bad horrible pain lately in the arm. It gets worse though the day and by the end of the day I can’t use my thumb or pick things up without warnting to cry. I still have the plate and screws in my arm. The pain isn’t just in my wrist it’s in my forearm on my surgical site as well. I have no idea what it could be or what to do!!

    1. Regenexx Team Post author

      Amanda,
      It could be any of the complications mentioned in the blog, the simplest of which would be arthritis. Studies have shown that additional undo force, rather than diminished force on the TFCC joint can result. But other things could be at play that should be looked into, so a current MRI would be a good place to start. If you’d like us to take a look, either make an appt at any of these locations: http://www.regenexx.com/find-a-physician/ or submit the Candidate form to upload the MRI and medical history: http://www.regenexx.com/hand-basal-joint-cmc-arthritis-treatment/

  10. Wendy Roach

    My daughter has complex regional pain syndrome and is only 21. We are concerned that it is a barbaric proposition to reduce the ulna. The ulna is 5.4 mm longer than the radius. We were told that it would solve the problem. After reading this article we are no confused especially as we do t want to trigger the RSD. She needs full function as she wants to be a veterinarian and is in her senior year. We are not sure what to do now. She has a complete tfcc tear.

    1. Regenexx Team Post author

      Wendy,
      It’s very wise not to take that step in a 21 year old who will need more than “full use” of her hands until all more conservative treatments are tried. Once the complete tfcc tear is repaired a clearer picture about whether additional treatment is needed, and if so, what. If you’d like us to take a look and see if her situation would be a good candidate, please submit the Candidate form so that her MRI ad medical history can be uploaded and she can speak with one of our physicians abut her case. Please see: http://www.regenexx.com/hand-basal-joint-cmc-arthritis-treatment/

      1. Heather walker

        Hi Wendy! I had a tfcc tear and had two arthroscopys one in 2002 and another in 2008. At the time of my first arthroscopy I was also diagnosed with regional pain syndrome type 2.

        After my second arthroscopy in 2008 I was still having the same problems with my wrist, this included the feeling that my wrist was dislocating itself which was extremely painful.

        After lots of physio, it takes longer to recover for regional pain syndrome sufferers, it was decided that my ulnar bone was too long and I should have it shortened.

        I had my second arthroscopy and ulnar shortening carried out by Ian trail at wrightington hospital in the uk, he is amazing.

        I am now 8 years in from my ulnar shortening. I don’t suffer with any of the previous problems that I had, however there are things I can’t do; boxing at a gym is one of these things as the impact causes a swelling in my arm around the plate area and when that happens it really hurts.

        The swelling can also occur if I do anything repetitive with my hand/arm, for example I can only write for a short time and typing this with one finger on my right hand, the side I have had shortened, also hurts.

        I’m not sure the swelling is normal but I manage fine and am still really glad I had the operation done as all my other pain has gone.

        I would say it is worth your daughter getting the operation done but be aware that I don’t believe anyone has this operation without side effects, but when I weigh it all up I’m glad I had it done.

        I hope this helps and gives you an insight into the future bearing in mind I had mine done 8 years ago!

        1. Regenexx Team Post author

          Heather,
          Glad to hear you feel the surgery helped you, despite the onging issues! Unlike the surgery, the precise image guided injections of patient’s own stem cells and platelets that we use to treat this issue non-surgically do not change the structure and biomechanics of the wrist. It simply corrects the “pull”. Unfortunately, these treatments are not yet available in the UK. Both importantly, our clinical experience and the research have shown that if you change the relationship between the radius and ulnar bones, you actually put more negative forces on the wrist. That doesn’t mean it can’t help an individual patient, it means that out of large groups of patients, the outcome is a net negative.

  11. Les Peterson

    My 21-year-old son just had hardware removed from his ulnar shortening procedure. He had suffered a fractured wrist, which was set in the ER and reset in surgery. Chronic pain and failure in PT resulted in consideration of alternatives at HarborView’s Hand Clinic. After much deliberation and imaging, the ulnar shortening procedure was suggested. It was performed, along with a “lashing” of the TFCC. (I remain unclear if that element of the procedure was an inherent component to the ulnar osteotomy.) After a year or so, my son had not gained full pronation, and had pain from the hardware. It was just removed 2 weeks ago in what we hope is his final surgery. HarborView’s chief hand surgeon said he only did a few of these shortening procedures a year, but made it sound like the original injury had altered the anatomy and mechanics of the TFCC to make my son a candidate.

    1. Regenexx Team Post author

      Les,
      So sorry to hear of your son’s experience. Unfortunately these are the types of things we hear from patients which is why we are so against this surgery.

  12. Kristen H

    I had this surgery a little less than a year ago (May 2016) and due to pain and discomfort had the plate removed in November of 2016. I was having pain on and off, but this past week it has gotten really bad again. It seems like any slight movement or use of my wrist causes pain. The only solution seems to be resting it (for hours on hours), but that is not possible because I am a 20 year old college student. I am not able to see my doctor until May, but even then, he never seems to take my complaints seriously. Do you have any suggestions for dealing with the pain or what to do going forward?

    1. Regenexx Team Post author

      Kristen,
      Unfortunately, your story is not uncommon which is why we’re not in favor of this surgery. You mentioned the plates were removed. Has the bone healed?

      1. Kristen H

        I was told that my bone had healed great (likely because I was so young). I was in a hard cast for 6 weeks and then a removable splint for about another month.

        1. Regenexx Team Post author

          Kristen,
          Please private message us on our Facebook page: wwww.facebook.com/Regenexx/.

  13. Jake

    It has been recommended that I get this procedure do to previous injuries from working construction and playing sports when I was younger. I am now in the military and I really have little options what I can do as far as medical treatment goes, and I’m almost positive they won’t pay for a visit let alone a procedure.. what are my options?

    1. Regenexx Team Post author

      Jake,
      Where are you based?

  14. Traysea

    I broke my wrist at the end of January and have been struggling ever since. I have recently had an MRI and it shows my ulna is restricting movement, causing the pain and needs to be shortened and realigned. They told me the radius has healed slightly shorter as a result of the break. Would this procedure not be the best for my circumstances? If not, could you point me in the right direction? I am concerned that it may result in my situation being prolonged if complications arise…!

    1. Regenexx Team Post author

      Traysea,
      There are often solutions that don’t inolve surgery , but we’d obviously need alot more information. Please submit the Candidate form to the right of the Blog, so you can upload the MRI and medical history and one of our Physicians can speak with you about whether and how we can help.

      1. Traysea

        I am in New Zealand… also it was a CT scan, my mistake. Is there any medical professionals you can suggest I speak to over here? I do not have access to my scan, I will see what I have to do to get it….
        Thank you

        1. Regenexx Team Post author

          Traysea,

          The closest we could recommend would be Dr. Boundy in Australia. Please see: http://www.nssm.com.au/

          1. Traysea

            Thank you!

  15. Linda Hill

    Hi, I had this surgery on Aug 31st 2011. It was a huge success, and very happy I had it done. On the outside of my left wrist I had a large lump, it was extremely painful. It was calcification from my body trying to repair the damage being caused in my wrist from the ulna being to long. My ulna was shortened and I now have a plate. The lump was removed and my wrist feels great. Only issue I have is when I accidentally hit the scar/plate area on something. It hurts really bad for a 5 seconds. If I had to do again I would!!!

    1. Regenexx Team Post author

      Linda,
      Very glad it helped! When we say something doesn’t work, we’re not saying that an individual patient can’t get benefit, we mean that out of a thousand pateints, the overwhelming majority experienced a net negative result. The most common issue is that instead of decreasing the load and pressure on the wrist, the surgery increases it, which has longterm biomechanical implications.

  16. Marilyn Mann

    I have been told I have ulnar impaction syndrome and also triangular fibrocartilage issues. The surgery you mention has not actually been recommended to me, but I read about it. In fact, I read the very study you linked to that showed the huge complication rates!
    However, I am unaware of evidence (e.g., randomized controlled trials) for the injections you mention. If there is such evidence, can you please point me to it.
    Best, Marilyn Mann

    1. Regenexx Team Post author

      Marilyn,
      While we have completed several Clinical studies and are recruiting for two currently, there are no published studies on that particular procedure. Our research, however, makes up 20% of the world’s peer reviewed published papers on patients who have received bone marrow stem cell procedures. on the safety and effectivemenss of the the stem cell Please see: https://regenexx.com/stem-cell-research/ and https://regenexx.com/hand-basal-joint-cmc-arthritis-treatment/

  17. Elizabeth Kanyua

    You did a good job of demeriting the current treatment methods, but alas! You must have forgotten to mention how were supposed to fix our painful wrists. Realistic alternative, maybe, coz the stem cell stuff is just not available to little people like me

    1. Regenexx Team Post author

      Elizabeth,
      By definition, surgery alters structure. In this particular surgery the surgeon removes a piece of the ulna to try and reduce pressure on the wrist, but regrettably research has shown that if you change the relationship between the radius and ulnar bones, you actually put more negative forces on the wrist. Ulnar impaction syndrome does not necessarily require stem cells and can often be treated with platelet procedures. Since this issue can be caused by things as seemingly unrelated as a neck issue, before such drastic surgery, it’s a good idea to get the type of exam that can track down the cause. Please see: https://regenexx.com/find-a-physician/

  18. Mr boog

    Hello, my problem started about 3 years ago when I was 27. My job at the time was really hands on and I started to feel tons of pain in my dominant wrist. I went to a specialist and took an MRI. The results were: Mild ulna positive variance. Irregularity and attenuation of the articular disc of the triangular fibrocartilage complex. Distal radial ulnar joint (DRUJ) and radiocarpel joint effusion. Also, chondromalacia with subchondral edma and subchondral cysts at the ulnar and proximal. Doctor told me that I need the ulnar shortening. I decided to wear the brace to bed and to work and soon the symptoms went away and I barely felt any pain at all. Then a few months ago I got another labor intensive job and my wrist pain came back 10X fold. I went back to him and he told me that I needed to ulnar shortened or I would be limited to anything physical my whole life. I quit that job 2 months ago and havn’t been doing anything really physical and I’ve been in tons of pain. He is the number 1 upper extremity doctor in my area and he has a 92% success rate with this surgery. He did tell me that most people need the hardware removed and people have problems with the incision. My surgery date is in 3 weeks and i’m really nervouse because even though I’ve seen some people do good with the surgery, I’ve also read a lot of bad things about it. The thing with me is my pain comes and goes(mostly when i’m doing something physical), like for the past 3 days I really haven’t felt any pain in my wrist at all. I asked the doctor about stem cell injections and he told me that it’s very expensive and the insurance doesn’t cover it. He also told me that the problem I’m having is mechanical and stem cell injections are only a temporary fix for the problem. I don’t know what I should do, i’m very close to cancelling the surgery though..

    1. Regenexx Team Post author

      Mr. boog,
      Love to help but unfortunately can’t advise in your case because we haven’t examined you. What we can say is that it is correct that stem cell procedures are not covered by insurance, but incorrect that the specific Regenexx procedure we do can’t fix the problem. It addresses and corrects the cause of the problem, unlike removing a section of ulna which ends up putting more force rather than less on the area. Imagine a door that doesn’t quite close. You could saw off the section of the door preventing it from closing, or you could fix the hinge which caused the door not to close. Whopping off a section of the door does not prevent the hinge from continuing to cause problems, fixing the hinge does. With doors, door hinges and door frames, all are easily replaced, not so with your wrist. If you’d like to see if you’d be a good candidate for this procedure, please submit the candidate form. Please see:
      https://regenexx.com/blog/difference-between-interventional-and-surgical-orthopedics/ and https://regenexx.com/blog/the-orthopedic-structural-paradigm-is-dead/

  19. Aaron Friend

    Hello, I am nineteen, and I have bilateral Madelung’s disease and also negative variance with impingement on both sides, as well. The impingement occurs right below the head of the radius, in both sides. On my both sides, the ulna is approximately 1.7 cm (not mm) shorter than the radius. On my right wrist, I have Kienböck’s disease. This lead to me having to have a total wrist fusion almost two weeks ago. About nine months ago, I started having the same kind of pain that I was having about five years ago, when my right wrist started hurting. It’s obviously too late to do anything for my right wrist, but can anything be done for my left?

    1. Regenexx Team Post author

      Aaron,
      Yes, we’d need to perform an exam, but we can likely help. If you’d like us to take a look, please submit the Candidate form to the right of the blog.

  20. Marby Shivwitz

    In ’96 and ’98 I had the end of my ulnas removed, everything reattached and the cartilage repaired due to the ulna being longer than the radius. The recovery time was lengthy but definitely better than the chronic pain I was in. The cartilage had been so crushed it took an hour to get the tip of the smallest needle in to inject the dye for the x-ray. I chose to have the surgery instead of repairing the cartilage so I wouldn’t have to possibly have it repaired again since the cause would have still been present, the longer ulna. My surgeon was one of the top hand surgeons in the U.S. at the time so maybe that added to my good fortune. I guess I’ve been rather lucky in that I haven’t had any additional issues with my wrists and now 20 years later I’m thinking about trying some light cardio boxing and see how these little puppies hold up.

    1. Chris Centeno Post author

      Marby, glad this worked out for you. We have seen many patients through the years that have not been so fortunate.

  21. Liz

    Had this sergury done twice aready and it seem to be worst . What can i do at this point my hand its even shorter they cut 2 inches and half and they cut part of the tendon is this even commun on this procedures? Can someone help

    1. Regenexx Team Post author

      Liz,
      Unfortunately, these are the kinds of results that are responsible for my advice to avoid the procedure.

  22. Joe Bloom

    I was hit by a car in 2011. I had a torn TFCC and no cartilage on the ulna side. They did a ulna shortening to stop the bone on bone grinding. 6 months ago I had another accident. The rest of the cartilage between my wrist and arm bones has been destroyed. The pain is horrible. My Doctor says too much damage. Nothing else he can do. I can Not live with this pain. Any suggestions please? It’s a work injury. Do you think they just don’t want to fix my wrist because of the cost? Thank you for the help. The pain will drive me crazy because I can’t get away from it.

    1. Regenexx Team Post author

      Joe,
      Constant pain affects more than just the the wrist. The original injury was likely fixable nonsurgically with precisie image guided injections of your own platelets andor stem cells, as we do that regularly. We have no way to know why your Doctor came to that decision. For us to offer any suggestions, we’d need more and different types of information. If you’d like us to weigh in, please submit the Candidate form to the right of the Blog.

  23. Holly Larson

    I’ve been diagnosed with ulnar impaction syndrome and have talked with two surgeons. One said shortening the bone was the only way and the other said there were two surgical options shortening or wafer. She stated neither have great results and that I should opt for cortisone shots 2x or less per year as needed. The first was great. The 2nd was good but then skin issues developed. The 3rd wasn’t as effective and skin breakage and bruising are now constant. I need to figure something else out and really want to be able to take yoga classes again. Suggestions?

    1. Regenexx Team Post author

      Holly,

      It’s about assessing and correcting the system, neck to hand. If you have TFCC problems or wrist pain, we’ve used minimally invasive injections of orthobiologics, like platelets and stem cells, for years to help these tissues heal. In addition, in our experience, the wrist commonly hurts due to bad biomechanics that are usually centered in a neck problem. Here irritated neck nerves give bad signals to the forearm muscles, and all of this places too much pressure on the wrist. Alternatively, an old injury to the wrist ligaments causes instability, and this results in excessive motion of the wrist bones leading to wear-and-tear arthritis. In either case, fixing the bad movement patterns or precisely injecting your own platelets or stem cells into the TFCC, arthritic wrist joints, ligaments, or neck usually reduces pain and increases function without invasive surgery. Please see: https://regenexx.com/hand-basal-joint-cmc-arthritis-treatment/ and https://regenexx.com/the-regenexx-procedures/back-surgery-alternative/

  24. Marcy

    I had an ulnar shortening done on my dominant hand in Feb 2010 & couldn’t be happier. I had experienced some discomfort then one day it became excruciating & I could barely move my wrist. I had broken that arm as a kid so I know what a broken bone feels like & I thought it was a stress fracture. They initially thought I had torn my TFCC based on my MRI but they found a huge hole in it where I was bone on bone. Yes, it’s not easy being in a full arm cast on your dominant hand but in my case….it was worth it. NO REGRETS!!

    1. Regenexx Team Post author

      Marcy,
      May have been a bone cyst. Please see: https://centenoschultz.com/why-is-my-hip-arthritis-getting-bad-so-fast/. We don’t recommend this surgery because the risk vs benefit profile is unacceptable, but that does not mean it can’t help an individual patient. Really happy it helped!

  25. Susan

    I am a paralegal working for a major insurance company. The work load in typing has escalated beyond human capacity. There are deadlines for 14 days to type up summaries of medical no matter how many you receive during that time. I have been in my profession for 30 years without issue until recent. I started having right wrist pain stiffness and throbbing pain to the point that I drop my toothbrush, difficultly brushing my hair, uncomfortable using a fork to turn the wrist to my mouth, just to name a few, cupping my hand to replicate using a mouse is excruciating and generates the symptoms. The ortho said my bone in wrist is larger than it should be and is striking the hand bone. He is also saying not work related due to bone deformity of larger bone. He wanted me back to work but at this point my wrist and hand are on fire. I had an injection today which has amplified the pain- he is saying next step is to shorten the bone tip

    1. Regenexx Team Post author

      Susan,
      The reason we don’t recommend this surgery is because the risk vs benefit profile is unacceptable. This is an issue we can often treat without the surgery. If you’d like to see if we can help in your case, please submit the Am I a Candidate form, or call 888 684 9919.

  26. Jane

    Can injections of orthobiologics, like platelets and stem cells also be used for a teen who has a longer ulna bone that is still growing and a radius that has stopped growing. There is no arthritis yet, but fluid at the end of the ulna, pain and unable to do many things with it that cause even slight pressure even after time spent doing physio.

    1. Regenexx Team Post author

      Jane,
      Accurate diagnosis is essential and we’d need to examine them see what’s going on in their particular case. We’d first need more information through a Candidacy review. Please call 866 684 9919 for assistance with that process.

  27. Robyn

    I have had the ulnar shortening operation done now I have a nonunion my arm has been broken for 9 months I have had a bone graph done which has died I’m so over this what can I do and will my arm ever heal

    1. Regenexx Team

      Hi Robyn,
      Very sorry to hear that. These are the types of scenarios that inspired this Blog, as what the ulna shortening surgery is designed to treat is actually a very common condition that we treat regularly with your own platelets and or stem cells. Please see: http://www.regenexx.com/hand-basal-joint-cmc-arthritis-treatment/ and http://www.regenexx.com/blog/texting-thumb-treatments/ To see if you would be a candidate for a Non-Union fracture procedure, https://regenexx.com/blog/wrist-nonunion-fracture-treatment/ and https://regenexx.com/conditions-treated/other-conditions/non-union-fractures/ please submit the “Am I a Candidate” form here: http://www.regenexx.com

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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Regenerative procedures are commonly used to treat musculoskelatal trauma, overuse injuries, and degenerative issues, including failed surgeries.
Select Your Problem Area
Shoulder

Shoulder

Many Shoulder and Rotator Cuff injuries are good candidates for regenerative treatments. Before considering shoulder arthroscopy or shoulder replacement, consider an evaluation of your condition with a regenerative treatment specialist.

  • Rotator Cuff Tears and Tendinitis
  • Shoulder Instability
  • SLAP Tear / Labral Tears
  • Shoulder Arthritis
  • Other Degenerative Conditions & Overuse Injuries
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Cervical Spine

Spine

Many spine injuries and degenerative conditions are good candidates for regenerative treatments and there are a number of studies showing promising results in treating a wide range of spine problems. Spine surgery should be a last resort for anyone, due to the cascade of negative effects it can have on the areas surrounding the surgery. And epidural steroid injections are problematic due to their long-term negative impact on bone density.

  • Herniated, Bulging, Protruding Discs
  • Degenerative Disc Disease
  • SI Joint Syndrome
  • Sciatica
  • Pinched Nerves and General Back Pain
  • And more
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Knee

Knees

Knees are the target of many common sports injuries. Sadly, they are also the target of a number of surgeries that research has frequently shown to be ineffective or minimally effective. Knee arthritis can also be a common cause for aging athletes to abandon the sports and activities they love. Regenerative procedures can be used to treat a wide range of knee injuries and conditions. They can even be used to reduce pain and delay knee replacement for more severe arthritis.

  • Knee Meniscus Tears
  • Knee ACL Tears
  • Knee Instability
  • Knee Osteoarthritis
  • Other Knee Ligaments / Tendons & Overuse Injuries
  • And more
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Lower Spine

Spine

Many spine injuries and degenerative conditions are good candidates for regenerative treatments and there are a number of studies showing promising results in treating a wide range of spine problems. Spine surgery should be a last resort for anyone, due to the cascade of negative effects it can have on the areas surrounding the surgery. And epidural steroid injections are problematic due to their long-term negative impact on bone density.

  • Herniated, Bulging, Protruding Discs
  • Degenerative Disc Disease
  • SI Joint Syndrome
  • Sciatica
  • Pinched Nerves and General Back Pain
  • And more
Learn More
Hand & Wrist

Hand & Wrist

Hand and wrist injuries and arthritis, carpal tunnel syndrome, and conditions relating to overuse of the thumb, are good candidates for regenerative treatments. Before considering surgery, consider an evaluation of your condition with a regenerative treatment specialist.
  • Hand and Wrist Arthritis
  • Carpal Tunnel Syndrome
  • Trigger Finger
  • Thumb Arthritis (Basal Joint, CMC, Gamer’s Thumb, Texting Thumb)
  • Other conditions that cause pain
Learn More
Elbow

Elbow

Most injuries of the elbow’s tendons and ligaments, as well as arthritis, can be treated non-surgically with regenerative procedures.

  • Golfer’s elbow & Tennis elbow
  • Arthritis
  • Ulnar collateral ligament wear (common in baseball pitchers)
  • And more
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Hip

Hip

Hip injuries and degenerative conditions become more common with age. Do to the nature of the joint, it’s not quite as easy to injure as a knee, but it can take a beating and pain often develops over time. Whether a hip condition is acute or degenerative, regenerative procedures can help reduce pain and may help heal injured tissue, without the complications of invasive surgical hip procedures.

  • Labral Tear
  • Hip Arthritis
  • Hip Bursitis
  • Hip Sprain, Tendonitis or Inflammation
  • Hip Instability
Learn More
Foot & Ankle

Foot & Ankle

Foot and ankle injuries are common in athletes. These injuries can often benefit from non-surgical regenerative treatments. Before considering surgery, consider an evaluation of your condition with a regenerative treatment specialist.
  • Ankle Arthritis
  • Plantar fasciitis
  • Ligament sprains or tears
  • Other conditions that cause pain
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Providers listed on the Regenexx website are for informational purposes only and are not a recommendation from Regenexx for a specific provider or a guarantee of the outcome of any treatment you receive.