Radially Based Extensor Retinacular Sling Reconstruction for Extensor Carpi Ulnaris Subsheath Injuries

Mastroianni, Michael; Leibman, Matthew; Belsky, Mark R.; Vitale, Mark A.; Ruchelsman, David E.

doi:10.1016/j.jhsg.2022.11.003

Cited by 2 publications

(6 citation statements)

References 18 publications

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“…In a series of 33 patients undergoing surgical reconstruction using a retinacular flap, preoperative imaging demonstrated ECU tenosynovitis in 54.5% and intrinsic ECU tendinopathy in 57.6%. 3 The small number of cases in our series demonstrated a complete resolution of ECU imaging pathology after surgical restabilization and restoration of a more normal movement pattern.…”

Section: Discussionmentioning

confidence: 61%

“…An unstable ECU tendon can develop chronic pathologic changes of tendinopathy. 3,9 Tendon stabilization can be achieved by a variety of different procedures. Simple suture of the torn edges of the ECU subsheath after appropriate debridement has been reported to be successful 2,10 but, particularly in athlete patients, the necessary narrowing of the dimensions when directly repairing the subsheath can affect smooth tendon excursion and limit end-range movement 8 creating a stenosing tenosynovitis.…”

Section: Discussionmentioning

confidence: 99%

“…It can lead to a painful ‘snapping’ sensation that limits function. An unstable ECU tendon can develop chronic pathologic changes of tendinopathy 3,9 …”

Section: Discussionmentioning

confidence: 99%

“…The technique of nonanatomic ECU stabilization using a local flap of extensor retinaculum has been previously reported and is regularly employed for cases of ECU subluxation. 3,5 In all cases in our study, the original surgeon had used a retinacular flap 4 that was harvested with its base at the Vth/VIth extensor compartment junction and with its radial limit extending to Lister tubercle (Figs. 4 and 5).…”

Section: Techniquementioning

confidence: 99%

“…The commonest technique for stabilization of the subluxing tendon involves the raising of a flap of extensor retinaculum 3 based on the radial side of the ECU tendon’s native location. This retinacular flap then wraps around the subluxing tendon, pulling it more radially—away from its original bony groove.…”

mentioning

confidence: 99%

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Revision of Failed Nonanatomic Extensor Retinacular Stabilization of the Unstable ECU Tendon: Surgical Technique and Case Series

Jones,

Campbell,

Campbell

2023

Techniques in Hand &Amp; Upper Extremity Surgery

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Nonanatomic surgical stabilization of the unstable extensor carpi ulnaris (ECU) tendon (where the subluxing tendon is re-routed away from the bony groove in the distal ulna) utilizes a flap of extensor retinaculum to create a new retaining sheath that will stabilize the tendon during forearm rotation movements. When this surgery fails, the extensor retinaculum tissue does not regenerate with sufficient structural strength to be used again. Previously, a different approach has then been needed for revision surgery, often using more complex surgical techniques with a substantially greater impact on recovery. We describe a highly reliable yet simple method of using local soft tissue to adequately restabilize the subluxing ECU tendon in cases where an extensor retinacular flap has already been used. We report the results of this technique in 4 patients, all of whom returned to jobs/hobbies where ECU instability was a considerable functional risk.

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Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 99%

“…It can lead to a painful ‘snapping’ sensation that limits function. An unstable ECU tendon can develop chronic pathologic changes of tendinopathy 3,9 …”

Section: Discussionmentioning

confidence: 99%

Section: Techniquementioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Revision of Failed Nonanatomic Extensor Retinacular Stabilization of the Unstable ECU Tendon: Surgical Technique and Case Series

Jones,

Campbell,

Campbell

2023

Techniques in Hand &Amp; Upper Extremity Surgery

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Radially Based Extensor Retinacular Sling Reconstruction for Extensor Carpi Ulnaris Subsheath Injuries in Elite Athletes

Mastroianni

Leibman

Belsky

et al. 2023

Hand (New York, N,Y.)

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Background: Extensor carpi ulnaris (ECU) subsheath injuries are an increasingly recognized cause of ulnar-sided wrist pain in elite athletes. There is a lack of surgical outcome data in elite athletes, and unique considerations exist for these patients. Methods: We performed a retrospective review of our hand center experience of 14 elite professional or collegiate athletes who prospectively underwent radially based extensor retinacular sling ECU subsheath reconstruction by 3 hand surgery-fellowship-trained surgeons between April 2011 and April 2021. Clinical, magnetic resonance imaging (MRI), and intraoperative findings were cataloged. Subgroup analyses of elite hockey players and acute subsheath injuries were also conducted. Statistical analysis was performed via a 2-tailed paired t test. Results: Mean age at the time of surgery was 21.3 years (range, 18-34). Mean time from symptom onset to surgery was 102.1 ± 110.7 days. All 14 patients underwent preoperative MRI. Five patients (35.7%) had intrinsic ECU tendinopathy, 9 patients (64.3%) had ECU tenosynovitis, 6 patients (42.9%) had triangular fibrocartilage complex tears, and 9 patients (64.3%) had ulnocarpal synovitis. Mean postoperative pain on a Visual Analog Scale was 0.25 ± 0.43. Grip strength ( P = .001), wrist flexion-extension ( P = .037), and pronosupination arcs ( P = .093) showed excellent recovery postoperatively. Mean time to unrestricted return to sports was 92.5 ± 21.0 days. There were no complications. Subgroup analyses found similar functional improvement and characterized injury patterns. Conclusions: Overall, our findings suggest surgical management of ECU subsheath injuries is a viable option in both acute and chronic settings in elite athletes and may be favorable compared with nonoperative management.

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Radially Based Extensor Retinacular Sling Reconstruction for Extensor Carpi Ulnaris Subsheath Injuries

Cited by 2 publications

References 18 publications

Revision of Failed Nonanatomic Extensor Retinacular Stabilization of the Unstable ECU Tendon: Surgical Technique and Case Series

Revision of Failed Nonanatomic Extensor Retinacular Stabilization of the Unstable ECU Tendon: Surgical Technique and Case Series

Radially Based Extensor Retinacular Sling Reconstruction for Extensor Carpi Ulnaris Subsheath Injuries in Elite Athletes

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