What is the ECU? AAROM/AROM exercises: consider taping ECU during this time to help maintain tendon stability, Rotator cuff strength and endurance exercises, Isometric -> isotonic wrist strengthening exercises, Including review of equipment (eg tennis racket grip -> greater risk of injury with a western or semi-western style of grip due to the high amounts of top spin generated). At a median follow-up of 8.4 years, the median PROMIS UE Physical Function score among 10 patients was 56, the median score for pain 0.5, and the median score for satisfaction 9.5. - recurrent subluxation of ECU tendon is characterized by painful "snap" over ulnodorsal aspect of wrist, particularly on forearm rotation; - ECU retinaculum can rupture and the tendon can leave its sheath; - this condition may be confused w/ recurrent subluxation of distal radioulnar joint; A T1-weighted axial image from a patient with an ECU subsheath stripping injury. 10 Xarchas KC, Leviet D. Non rheumatoid closed rupture of extensor carpi ulnaris tendon. The supratendinous retinaculum courses medially, surrounding the ulna. A shoulder subluxation occurs when the humerus partially slides in and out of place quickly (Figure 2). When the fibro-osseous sheath is ruptured and deemed irreparable, reconstruction is accomplished using a retinacular sling or free retinacular graft (see, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on Surgical Treatment for Extensor Carpi Ulnaris Subluxation, Corrective Osteotomy for Metacarpal and Phalangeal Malunion, Extensor Tendon Centralization following Traumatic Subluxation at the Metacarpophalangeal Joint, Dorsal Block Pinning of Proximal Interphalangeal Joint Fracture-Dislocations, Corrective Osteotomy for Radius and Ulna Diaphyseal Malunions, Vascularized Bone Grafting and Capitate Shortening Osteotomy for Treatment of Kienbck Disease, Operative Treatment of Thumb Carpometacarpal Joint Fractures. Available from: https://www.orthobullets.com/hand/6030/snapping-extensor-carpi-ulnaris-ecu. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. This joint laxity may cause pain and dysfunction, eventually leading to degenerative changes. The tendon itself, passes under the extensor retinaculum within a synovial sheath that forms the 6th compartment of the wrist, within a grove lateral to the ulna styloid process. If the addition of ECU contraction is required for frank dislocation, some inherent stability remains. Graham TJ. ,1*.M Disabilities of the Arm, Shoulder & Hand Questionnaire, https://www.physio-pedia.com/index.php?title=Extensor_Carpi_Ulnaris_(ECU)_Subluxation&oldid=301769. A spectrum of possibilities ranging from injury to the ECU tendon to pathologic conditions of the tendon should also be considered, including tendinosis/tendonitis, subluxation, traumatic dislocation, or even rupture. Themes UFO. The tendon lies slightly more palmar than is typical. Our cohort consisted of 6 male and 9 female patients. Please contact us as soon as possible to schedule an appointment with our talented team. Types of Shoulder Instability Surgery. Tenosynovitis and tendinosis of the ECU are not uncommon, with these abnormalities being a frequent early finding in patients with rheumatoid arthritis.2 In athletes, the ECU is the second most common site of wrist tendinopathy,3 typically associated with rowing, racquet sports, and golf. The treatment can be conservative but sometimes it requires surgical treatment. It is important that athletes and individuals alike seek treatment from a highly qualified surgeon, with specialization in treating injuries of the hand and wrist in order to assess if they are getting the proper diagnosis and care. Patients present with complaints of pain, swelling, and stiffness. The extensor carpi ulnaris (ECU) tendon has a distinct subsheath at the distal ulna, separate from the extensor retinaculum. Resting the arm during sports activities can aid in the prevention of substantial tears. ECU is the standard medical acronym for Extensor Carpi Ulnaris, which is the muscle/tendon that runs along the outside of the upper side of the hand and is integral in the extension of the carpal bones, as its name implies. The subsheath can be injured with forced supination, ulnar deviation, and wrist flexion, resulting in the ECU tendon subluxing in the palmar and ulnar directions during wrist circumduction. Lateral epicondyle of the humerus via the common extensor tendon. *Figures courtesy of Principles of Hand Surgery and Therapy by Thomas E. Trumble, MD, Ghazi M. Rayan, MD, Mark E. Baratz, MD and Jeffrey E. Budoff, MD, Phone: (425) 999-3580 A T1-weighted axial imageat the level of the distal ulna. The subsheath lies deep to the extensor retinaculum, which itself does not attach to or stabilize the ECU tendon. Recovery After extensor carpi ulnaris tendonitis surgery, you will wake up in a splint or cast to help stabilize your wrist and minimize unnecessary movement. ECU injuries can often be managed conservatively. Existing patients, click here. 50% of surgical cases also find a TFCC tear. The guiding principles for surgical repair depend on the essential osteofibrous sheath lesion present at the time of surgery. https://www.orthobullets.com/hand/6030/snapping-extensor-carpi-ulnaris-ecu, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5735293/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9036339/. Certain patterns of injury require operative repair, and thus MRI is a critical component of the treatment planning process. Surgery for cartilage tears or instability is not an emergency. Here are a couple resources on the injury. In such cases, the ECU subsheath never heals, and the tendon may remain in an abnormally palmar location relative to its ulnar groove (P). Uncommon, ruptures are typically repaired using a local graft, primarily the palmaris longus. That is why it is so important for individuals to seek medical attention when they notice discomfort, particularly with wrist rotation. Palpating the ECU groove will likely elicit pain and tenderness for the patient if the ECU is involved in the mechanism of injury. The tendon itself lies within a bony groove along the dorsal, distal ulna. This handout explains the follow-up care after surgery to stabilize the extensor carpi ulnaris (ECU) tendon. Subluxation means that the sheath is trapped between the radius and ulna, and so any kind of traumatic injury that turns the bones in such a manner that they impinge upon the sheath can also create the condition. ECU subluxation most often presents with a searing pain to the affected area, being the ulnar aspect of the wrist. ECU Tendon Subluxation: Snapping Wrist Syndrome, Compartment 1: Abductor Pollicus Longus and Extensor Pollicus Brevis, Compartment 2: Extensor Carpi Radialis Longus, Extensor Carpi Radialis Brevis, Compartment 4: Extensor Indicis Proprius, Extensor Digitorum Communis, Posterior Interosseous Nerve. Acute traumatic subluxation of the extensor carpi ulnaris tendon at the wrist. @}mpP6/ML%u`D-?*N^(Sl{Geq26hG? Seldom is a surgical procedure needed for treatment of ECU tendonitis, but if symptoms persist despite appropriate management, a surgical debridement of the tendon can be considered. Though within professional Rugby League in England, it has been found that the incidence of acute ECU injury is 1 injury/60 players/year, with a significant proportion (50%) requiring surgical repairs in this cohort[1]. If the skin around the incision is red or if there is drainage coming out of it please call us right away. A/ A dorsal ulnar incision was made; care being made to identify and protect any crossing sensory branches of the dorsal ulnar nerve. Symptomatic tears of this subsheath and subluxation of the ECU tendon often require reconstruction of the subsheath. Subluxation of the ECU Tendon Associated with the ED Tendon Subluxation of the Long Finger Clinics in Orthopedic Surgery Vol. The sensation of tendon dislocation and an associated pop may accompany the injury. Depending on the severity of injury, immobilization is necessary for six weeks to three months. 2021;22(1):387. doi: 10.1186/s12891-021-04271-z. It's held in this position by a ligament. Hand Clin. Acute extensor carpi ulnaris (ECU) subsheath injury and chronic subsheath insufficiency may result in symptomatic ECU instability at the level of the distal ulna osseous sulcus. The ECU subsheath is diffusely torn and irregular. ECU Tendon Problems and Ulnar Sided Wrist Pain. Injury to the tendon may be acute, chronic, or anatomical based. A positive ECU synergy test appears sensitive although not 100% specific for ECU tendinopathy. ECU injury presents with ulnar-sided wrist pain. Surgery for Wrist Tendonitis Following surgery, a special cast is worn for 6 weeks. Labral repair or capsulorraphy are an elective outpatient procedure that can be scheduled when circumstances are optimal. J Hand Surg 2001; 26(6): 556-559. Local steroid injections may also be beneficial, though they must be used with caution due to an increased risk of tendon and ligament degeneration and tearing. If you suffer an injury while playing sports or participating in physical activity, sports medicine rehabilitation can speed up the healing process and lower your risk of future complications. Do not drive if you are taking narcotic medication, as it is unsafe and against Washington state law. Clinical History: A 44 year old recreational tennis player complains of chronic, worsening ulnar sided wrist pain. Summer Trusty, has worked as a physical therapy technician at the Orthopedic Center for Sports Medicine (OCSM). Fat-suppressed proton density weighted images from a patient with chronic ulnar sided wrist pain. Chronic subluxation of the ECU tendon over the ulnar prominence of the groove in the distal ulna can lead to painful snapping of the tendon with supination and pronation. Extensor carpi ulnaris injuries in tennis players: a study of 28 cases. In both instances, the ECU tendon is destabilized and subluxates ulnarly and volarly over the distal ulna beneath an intact dorsal retinaculum. During surgery, the groove that the ECU sits in is deepened and the ECU sheath is reattached to bone. ECU subluxation is caused when the sheath that containes the ECU ligament gets pinched between the radius and ulna, and this type of damage is most often caused by the repetitive motion associated with playing golf or tennis, but it can also be the result of trauma to the wrist/forearm. Her additional health-related coverage includes death and dying, skin care, and autism spectrum disorder.