Extensor Carpi Ulnaris Problems at the Wrist–Classification, Surgical Treatment and Results

Abstract

Twenty-eight extensor carpi ulnaris lesions at the wrist were treated surgically between 1990 and 2002. Fifteen patients had an isolated extensor carpi ulnaris tenosynovitis or tendinopathy, five had extensor carpi ulnaris dislocation, four had an extensor carpi ulnaris subluxation and four had an extensor carpi ulnaris rupture. Seventeen patients first developed their symptoms while playing sports. At a mean follow-up of 23 months, twenty-two patients had returned to their previous activities. Seven of the 27 patients had lost more than 30% of their grip strength and five had restricted wrist motion. Two needed an extensor carpi ulnaris tenolysis. Pure isolated extensor carpi ulnaris lesions are rare and associated ulnar sided lesions (eleven triangular fibrocartilage complex tears and four lunotriquetral ligament tears), as well as possible predisposing factors (seven anomalous tendon slips, four ulnar styloid non-unions and one flat extensor carpi ulnaris tendon groove), were frequent. A classification of extensor carpi ulnaris tendon and subsheath lesions was developed to allow the surgeon to adequately evaluate the different components of these lesions.

Anatomical Variations of the Extensor Carpi Ulnaris Groove: A New Computed Tomography-based Evaluation

“…Deepening of the ECU groove has been reported recently to treat tendon instability or subluxation, based on the theory that a shallow or flat ECU groove leads to recurrent ECU tendon dislocations. [3][4][5] However, the optimal depth remains unknown, although 1.5-2 mm has been suggested. 6) On the other hand, Graham et al 9) cautioned against overaggressive deepening of the groove, noting that the tendon may have a greater tendency to subluxate if there is a loss of the medial buttress.…”

Ulnar-sided wrist pain in the athlete (TFCC/DRUJ/ECU)

“…Division of the tendon in the affected area and debridement of necrotic tissue diminishes tendon size and may help alleviate symptoms. Surgical exploration also allows for evaluation of any extraneous septa between the ECU and extensor digiti minimi which may be released [17]. Release of the division between the fifth and sixth extensor compartments should also be considered to help decompress the sixth compartment, which can contribute to improvement of symptoms [27].…”

“…In cases of periosteal avulsion, the avulsed periosteum should be reapproximated with transosseous fixation or suture anchors. When the sheath itself is torn or elevated from its insertion, direct repair may be attempted or reconstruction of the sheath should be completed using a strip of extensor retinaculum or periosteum [16,17,29,30].…”

“…However, if this injury occurs in an active patient, reconstruction of the tendon with the use of palmaris longus graft should be considered [17].…”

“…For procedures involving simple synovectomy with or without debridement, we recommend wrist immobilization for 2 weeks in a short arm splint. [17] If reconstruction of the ECU sheath as described above is performed, we recommend immobilization in a long arm cast for 4-6 weeks with the forearm in neutral rotation and elbow at 90°. We recommend restricting return to sport or vigorous activity for another 2 months after immobilization is discontinued and therapy has begun [16,17].…”