Extensor carpi ulnaris tendinopathy
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Extensor carpi ulnaris (ECU) tendinopathy is varied and includes tendinosis, (stenosing) tenosynovitis, tendon subluxationinstability and rarely rupture.
Epidemiology
Athletes in racquet or club sports are at increased risk of ECU tendinopathy include those who participate in 1,2:
- racquet sports, e.g. tennis
- club sports, e.g. golf
- high-impact contact sports, e.g. rugby
Clinical presentation
Patients typically present with ulnar-sided wrist pain and/or pain on wrist extension. Localised swelling may be present.
A positive ECU synergy test appears sensitive although not 100% specific for ECU tendinopathy. With the elbow in 90º flexion and the forearm in full supination, resistance to thumb abduction with counter pressure on the middle finger. Reproduction of dorsal-ulnar wrist pain is considered positive for ECU tendinopathy although the test may also be positive in triangular fibrocartilage complex or lunotriquetral pathology 1.
Pathology
Numerous pathologies can affect the ECU tendon 2:
-
tenosynovitis
- causes by repetitive wrist flexion/extension, especially in supination
- in non-athletes, consider rheumatoid arthritis
- stenosing tenosynovitis is rare
-
tendinosis
- results from overuse
-
tendon instability
- ranges from subluxation to gross dislocation
- results from ECU subsheath injury/dysfunction
- usually the result of single acute trauma
Radiographic featuresappearance
Content pendingUltrasound and MRI are the mainstays of ECU tendon imaging, with ultrasound offering the advantage of dynamic assessment, Doppler interrogation for inflammation and assessment of the contralateral ECU tendon 2.
Differential diagnosis
Other causes of ulnar-sided wrist pain should be considered such as 2,3:
- triangular fibrocartilage complex injury
- lunotriquetral ligament injury
- distal radio-ulnar arthropathy
- ulnar styloid fracture
Practical points
- ECU tendon sheath becomes more prominent distal to the ulnar styloid and should not be mistaken for tenosynovitis 2
-<p><strong>Extensor carpi ulnaris </strong>(<strong>ECU</strong>)<strong> tendinopathy</strong> is varied and includes tendinosis, (stenosing) tenosynovitis, tendon subluxation and rarely rupture. </p><h4>Epidemiology</h4><p>Athletes in racquet or club sports are at increased risk of ECU tendinopathy <sup>1</sup>.</p><h4>Clinical presentation</h4><p>Patients typically present with ulnar-sided wrist pain and/or pain on wrist extension. Localised swelling may be present. </p><p>A positive ECU synergy test appears sensitive although not 100% specific for ECU tendinopathy. With the elbow in 90º flexion and the forearm in full supination, resistance to thumb abduction with counter pressure on the middle finger. Reproduction of dorsal-ulnar wrist pain is considered positive for ECU tendinopathy although the test may also be positive in triangular fibrocartilage complex or lunotriquetral pathology <sup>1</sup>.</p><h4>Radiographic features</h4><p><em>Content pending.</em></p>- +<p><strong>Extensor carpi ulnaris </strong>(<strong>ECU</strong>)<strong> tendinopathy</strong> is varied and includes tendinosis, (stenosing) tenosynovitis, tendon instability and rarely rupture. </p><h4>Epidemiology</h4><p>Athletes at increased risk of <a title="Extensor carpi ulnaris" href="/articles/extensor-carpi-ulnaris">ECU</a> tendinopathy include those who participate in <sup>1,2</sup>:</p><ul>
- +<li>racquet sports, e.g. tennis</li>
- +<li>club sports, e.g. golf</li>
- +<li>high-impact contact sports, e.g. rugby</li>
- +</ul><h4>Clinical presentation</h4><p>Patients typically present with ulnar-sided wrist pain and/or pain on wrist extension. Localised swelling may be present. </p><p>A positive ECU synergy test appears sensitive although not 100% specific for ECU tendinopathy. With the elbow in 90º flexion and the forearm in full supination, resistance to thumb abduction with counter pressure on the middle finger. Reproduction of dorsal-ulnar wrist pain is considered positive for ECU tendinopathy although the test may also be positive in triangular fibrocartilage complex or lunotriquetral pathology <sup>1</sup>.</p><h4>Pathology</h4><p>Numerous pathologies can affect the ECU tendon <sup>2</sup>:</p><ul>
- +<li>
- +<a href="/articles/tenosynovitis">tenosynovitis</a><ul>
- +<li>causes by repetitive wrist flexion/extension, especially in supination</li>
- +<li>in non-athletes, consider rheumatoid arthritis</li>
- +<li>stenosing tenosynovitis is rare</li>
- +</ul>
- +</li>
- +<li>
- +<a title="Tendinosis (general)" href="/articles/tendon-pathology">tendinosis</a><ul><li>results from overuse</li></ul>
- +</li>
- +<li>tendon instability<ul>
- +<li>ranges from subluxation to gross dislocation</li>
- +<li>results from ECU subsheath injury/dysfunction</li>
- +<li>usually the result of single acute trauma</li>
- +</ul>
- +</li>
- +</ul><h4>Radiographic appearance</h4><p>Ultrasound and MRI are the mainstays of ECU tendon imaging, with ultrasound offering the advantage of dynamic assessment, Doppler interrogation for inflammation and assessment of the contralateral ECU tendon <sup>2</sup>. </p><h4>Differential diagnosis</h4><p>Other causes of ulnar-sided wrist pain should be considered such as <sup>2,3</sup>:</p><ul>
- +<li>triangular fibrocartilage complex injury</li>
- +<li>lunotriquetral ligament injury</li>
- +<li>distal radio-ulnar arthropathy</li>
- +<li><a title="Ulnar styloid fracture" href="/articles/ulnar-styloid-fracture-2">ulnar styloid fracture</a></li>
- +</ul><h4>Practical points</h4><ul><li>ECU tendon sheath becomes more prominent distal to the ulnar styloid and should not be mistaken for tenosynovitis <sup>2</sup>
- +</li></ul>
References changed:
- 2. Campbell D, Campbell R, O'Connor P, Hawkes R. Sports-related extensor carpi ulnaris pathology: a review of functional anatomy, sports injury and management. (2013) British journal of sports medicine. 47 (17): 1105-11. <a href="https://doi.org/10.1136/bjsports-2013-092835">doi:10.1136/bjsports-2013-092835</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/24096897">Pubmed</a> <span class="ref_v4"></span>
- 3. Mark D. Miller, Stephen R. Thompson. DeLee and Drez's Orthopaedic Sports Medicine E-Book. (2009) <a href="https://books.google.co.uk/books?vid=ISBN9781437721713">ISBN: 9781437721713</a><span class="ref_v4"></span>
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