Ulnar-wrist pain is a complex problem whose cause often remains elusive. A diagnostic triad of localized triquetral pain, history of a wrist hyperflexion injury, and normal radiographs, accompanied by ulnar wrist swelling and limited wrist motion, is often attributable to a syndrome we have termed triquetral impingement ligament tear (TILT). The mechanism of injury causes a cuff of fibrous tissue to be displaced distally from the ulnar sling mechanism, resulting in chronic impingement on the triquetrum that causes hyperaemia, loss of articular cartilage, and softening of the bone. Surgical repair consists of simply excising the impinging fibrous cuff. The outcome of 44 patients treated for TILT over a 6-year period is reviewed. In all cases, TILT repair resulted in improved wrist motion and strength. Ninety-five percent of patients reported a significant improvement in pain both at rest and with activity.