Extensor Carpi Ulnaris Tendinopathy 


Extensor Carpi Ulnaris Tendinopathy 

ECU tendinopathy refers to an overuse injury affecting the extensor carpi ulnaris (ECU) tendon. This tendon originates in the forearm and inserts at the base of your pinky finger, which plays an important role in extending your wrist and moving your hand to the pinky side (ulnar deviation). When the ECU tendon becomes overloaded by repetitive strain or microtrauma, it can develop inflammation, degeneration, or tears, leading to ECU tendinopathy.

What are the Symptoms?

The most common symptoms of ECU tendinopathy include:

What are the Causes & Risk Factor?

Several factors can contribute to ECU tendinopathy:

  • Repetitive hand and wrist activities: Activities that involve repetitive gripping, forced wrist extension, or ulnar deviation can overload the ECU tendon, such as weightlifting, certain sports (golf, tennis), or using tools. Do those that require a strong grip. 
  • Improper technique: Improper form during exercises or activities that put too much stress on the wrist and forearm can increase the risk of ECU tendinopathy. 
  • Sudden increases in activity: Sudden increases in the intensity or duration of activities that involve wrist extension or ulnar deviation can stress the ECU tendon, especially if proper conditioning is not followed. 
  • Previous wrist injury: A previous wrist sprain or fracture can weaken the muscles and tendons, making them more susceptible to overuse injuries like ECU tendinopathy. 

Predisposing factors of ECU Tendinopathy

Certain factors can increase your risk of developing ECU tendinopathy:

  • Occupations: People whose jobs require repetitive gripping, forced wrist extension, or ulnar deviation are more prone to this condition, such as athletes (golfers, tennis players), construction workers, or mechanics. 
  • Sports participation: Athletes who participate in sports that involve repetitive wrist movements, such as golf, tennis, or weightlifting, are at higher risk. 
  • Age: Although ECU tendinopathy can occur at any age, it is more common in middle-aged adults. 
  • Previous wrist injury: A previous wrist injury can increase the risk of ECU tendinopathy. 
  • Poor grip strength: Poor grip strength can put extra stress on the ECU tendon during activities. 

Diagnosis of ECU Tendinopathy

The diagnosis of ECU tendinopathy usually includes:

  • Physical examination: A health care professional will examine your wrist and hand. They will move the area to identify the location of the tenderness and assess the intensity of the pain with specific movements. 
  • Strength testing: Specific tests can be done to assess the strength of the wrist and hand muscles. 

Imaging tests are not always necessary for diagnosis but can sometimes be helpful in ruling out other conditions: 

  • X-rays: X-rays can help identify bony abnormalities in the wrist, but they do not directly visualize soft tissues such as tendons. 

Treatment options for ECU Tendinopathy

Treatment for ECU tendinopathy focuses on reducing pain, inflammation, and promoting healing of the affected tendon. Here’s an overview of common treatment options:

  • Rest: Avoiding activities that aggravate pain, especially those that involve strong wrist extension, ulnar deviation, or repetitive gripping, is essential for early healing.
  • Ice therapy: Applying an ice pack to the affected area for 15 to 20 minutes at a time, several times a day, can help reduce pain and inflammation.
  • Pain medications: Over-the-counter pain relievers (ibuprofen, acetaminophen) or prescription medications may be used to manage pain and discomfort.
  • Orthosis or splint: Wearing a wrist splint or splint can help immobilize and provide support to the wrist, reducing strain on the ECU tendon. The specific type of corset and duration of use will be determined by a healthcare professional.
  • Stretching and strengthening exercises: Gentle stretching exercises to improve flexibility and range of motion in the wrist and arm. Exercises to strengthen the muscles around the wrist and arm can improve stability and prevent future problems. The exercises will specifically target the ECU tendon and the muscles that support it.
  • Corticosteroid injection: In some cases, injecting corticosteroids directly around the ECU tendon can relieve pain and reduce inflammation. However, repeated injections are not recommended due to possible side effects.

Surgery for ECU tendinopathy is rarely necessary and is usually only considered if conservative treatment fails to provide significant improvement after a long period of time (usually several months). The most common surgical procedure is: 

  • Tenosynovectomy: This outpatient surgery involves removing inflamed tissue around the ECU tendon or repairing the torn tendon. This procedure can allow more room for the tendon to slide more easily and reduce friction. 

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