Ulnar styloid impaction is characterized by the impaction of the triquetrum against the ulnar styloid causing chondromalacia, synovitis and ulnar-sided wrist pain. The causes are multiple but include any cause that brings the carpus closer to the ulnar styloid and vice versa. There is a history of ulnar-sided wrist pain. On examination, pain is provoked by Ruby’s test. Plain radiographs may reveal a relatively long ulnar styloid process and progressive degenerative changes on the ulnar styloid and upon the triquetrum. Treatment has been traditionally centred upon open ulnar styloidectomy as arthroscopic techniques were thought to place the triangular fibrocartilaginous complex at risk. A more recent arthroscopic technique is described that is effective whilst safe to ligamentous structures and with minimal postoperative morbidity for the patient.