Recurrent Dislocation of The Extensor Carpi Ulnaris Tendon in a Water-Polo Athlete

Stathopoulos, Ioannis P.; Raptis, Konstantinos; Ballas, Efstathios G.; Spyridonos, Sarantis

doi:10.5812/traumamon.19551

Cited by 9 publications

(5 citation statements)

References 17 publications

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“…There is a prevalence study in the literature that was based on a population of professional athletes (such as tennis players, rowers, polo players, and golfers) only [13][14][15]. In the present study, an asymptomatic population was evaluated, and the plan was to determine the prevalence among the general population.…”

Section: Discussionmentioning

confidence: 99%

“Snapping” of the extensor carpi ulnaris tendon in asymptomatic population

Erpala¹,

Öztürk

2021

BMC Musculoskelet Disord

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Background Extensor carpi ulnaris tendinopathy (ECU) can be one cause of ulnar side wrist pain and it is more prominent in pronation-supination movements against resistance. In supination, flexion, and ulnar deviation within the ulnar groove, the tendon is tense and becomes predisposed to subluxation or dislocation. Snapping occurs during this dislocation and relocation. As a result of this friction between the tendon sheath and ulnar groove, tendinopathy and pain occur. ECU tendon is an important structure that contributes to the dynamic stability of wrist therefore resulting degeneration contributes disruption of distal radioulnar joint and causes wrist instability. Methods Participants without active wrist complaints who presented to the outpatient clinic between 2019 and 2020 were included. Provocation test was performed and participants with snapping were evaluated with ultrasound to determine subluxation or dislocation. Participants asked to indicate approximately how much time they spent daily on the phone, computer and game console. The distribution of data was evaluated with the Kolmogorov-Smirnov test. Quantitative data that were not normally distributed were evaluated using the Mann-Whitney U test, and Student’s t-test was used for normally distributed data. The Chi-square test was used to compare categorical variables. For all tests, p < 0.05 was considered statistically significant. Results Four hundred and fifteen women and 340 men were included in the study. Fifty of the 755 participants (6.6 %) had snapping. 22 of the 755 participants (2.9 %) had dislocation or subluxation on ultrasound. Three (13.6 %) participants had dislocation and 19 (%86.4) participants had subluxation on ultrasound. All 50 of the participants with snapping had significant repetitive trauma and sports activities. It was determined that 21 of the 22 participants who were found to have subluxation or dislocation by ultrasound had more than two hours of hobby activity and significantly more participants had more than two hours of activity compared to the group without subluxation or dislocation. Conclusions This study with a large number of participants will contribute to the literature in terms of evaluating the contribution of technological devices, such as computers, smartphones, and consoles to chronic wrist pain and the prevalence of ECU snapping in the asymptomatic population. Trial registration Date of Approval; 19.02.2019, Approval Number; 19-KAEK-045.

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Section: Discussionmentioning

confidence: 99%

“Snapping” of the extensor carpi ulnaris tendon in asymptomatic population

Erpala¹,

Öztürk

2021

BMC Musculoskelet Disord

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“…19 To date, it is unclear whether the depth of the ulnar groove plays a role in which patients incur such injuries. 20 As such, it has been theorized that deepening the ulnar groove during the subsheath repair will aid in the stability of the repair, and prevent future re-subluxation.…”

Section: Discussionmentioning

confidence: 99%

An Analysis of Extensor Carpi Ulnaris Groove Morphology and Tendon Instability

Shoap

Dennis

Lombardi

et al. 2022

Hand (New York, N,Y.)

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Background: The extensor carpi ulnaris (ECU) tendon has a distinct subsheath at the distal ulna. Symptomatic tears of this subsheath and subluxation of the ECU tendon often require reconstruction. We sought to determine the anatomical constraints of the ECU subsheath. Methods: The ECU subsheath was exposed on 12 fresh-frozen upper extremities. The tip of the ulnar styloid, the distal ulnar joint surface, and the proximal extent of the distal radio-ulnar joint were identified and dimensions measured. Subluxation of the tendon was then assessed with and without an intact subsheath in 9 specimens. The travel of the tendon was measured in pronation through supination and flexion before and after sectioning of the subsheath. Results: The ECU subsheath is 8.9 mm (standard deviation [SD] = 0.8 mm) wide proximally and 9.0 mm (SD = 1.2 mm) distally. The distal ulnar insertion is 0.5 mm (SD = 0.8 mm) proximal to the tip of the styloid, and stretches 10.2 mm (SD = 2.7 mm) proximally. From maximum pronation to maximum supination and flexion, the ECU tendon traveled 3.32 mm (SD = 4.24) medially when the subsheath was intact and 5.42 mm (SD = 5.0 mm) after sectioning. The maximum depth of the ulnar groove was 2.5 mm (1.59-3.56 mm). There was no significant association between changes in ECU subluxation and the depth of the ECU groove (Spearman’s rho = 0.25). Conclusion: The ECU subsheath is roughly 1 cm square stretching proximally from the ulnar styloid. ECU groove depth is not a significant independent predictor of tendon subluxation.

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“…The ECU muscle originates from the lateral epicondyle of humerus and runs along the middle third of the dorsal surface of ulna. It inserts at the base of the fifth metacarpal [ 2 - 4 ]. It is kept secure in the distal ulnar groove in a fibro-osseous tunnel by a fibrous sheath deep to the extensor retinaculum as described by Spinner and Kaplan, termed as the subsheath.…”

Section: Discussionmentioning

confidence: 99%

“…Provocative maneuvers such as supination, palmar flexion, and ulnar deviation will elicit or worsen the pain. These maneuvers may elicit palpation of the dislocated ECU tendon, which is otherwise not elicited in the neutral position [ 4 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

Tennis Players and Water Polo Athletes Now Have Something in Common to Talk About: MRI Findings of Extensor Carpi Ulnaris Chronic Subsheath Injury

Gupta

Bhatt

Bansal

et al. 2018

Cureus

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Pathologies of the extensor carpi ulnaris (ECU) tendon are often due to de Quervain's tenosynovitis of the first dorsal compartment among the wrist tendon pathologies. A common cause for tendinitis and tenosynovitis of the ECU tendon is its dislocation. ECU dislocation is unique among all wrist tendon injuries due to its typical location within a fibro-osseous tunnel bordered by a fibrous sheath, which is termed as the subsheath. The subsheath is the main anatomic structure keeping the ECU tendon within the tunnel. Subsheath tears can lead to a fixed or dynamic pattern of ECU dislocation. This injury is more often seen in tennis players and golfers than in water polo athletes, as there are overall fewer water polo athletes when compared to tennis players and golfers. In this article, we will discuss the mechanisms, clinical presentation, magnetic resonance imaging (MRI) findings, differential diagnoses, and management options for chronic subsheath tears.

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Recurrent Dislocation of The Extensor Carpi Ulnaris Tendon in a Water-Polo Athlete

Cited by 9 publications

References 17 publications

“Snapping” of the extensor carpi ulnaris tendon in asymptomatic population

“Snapping” of the extensor carpi ulnaris tendon in asymptomatic population

An Analysis of Extensor Carpi Ulnaris Groove Morphology and Tendon Instability

Tennis Players and Water Polo Athletes Now Have Something in Common to Talk About: MRI Findings of Extensor Carpi Ulnaris Chronic Subsheath Injury

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