The ulnocarpal joint plays a critical role in hand and wrist function. It serves as part of forearm rotation as well as part of the carpal kinematics. The joint is comprised of the distal radio-ulnar articulation, triangular fibrocartilage complex, lunate, triquetrum, hamate, and pisiform, and the intra and extracapsular ligamentous and soft tissue constraints. Traumatic disruptions as well as chronic inflammatory conditions are commonplace. In addition to standard radiographs, arthrography, CT scanning, and MRI studies prove useful. Wrist arthroscopy is becoming of increasing importance in this region of the wrist. Ulnar impaction syndrome may occur associated with malunion of distal radius fracture, ulna positive variance, or chronic TFCC tears. Osteotomy of the distal radius or ulnar shortening osteotomy should be considered. Instability of the distal ulna can be treated with tenodesis procedures, hemi-resection arthroplasty, matched ulna resection or the Sauvé-Kapandji procedure.