The cornerstone of ulnar abutment syndrome is unloading the ulnocarpal joint by recession of the distal ulna. In the presence of a central perforation of the TFCC, it is possible to perform the recession arthroscopically. Arthroscopic wafer resection allows quicker recovery and avoids the morbidity and complications of ulnar shortening. Wafer resection, however, is limited to cases where only a few millimeters of ulna shortening is needed. Additionally, in the presence of advanced LT instability, diaphyseal shortening of the ulna may be preferable.