Relative Contribution of the Subsheath to Extensor Carpi Ulnaris Tendon Stability: Implications for Surgical Reconstruction and Rehabilitation

Ghatan, Andrew C.; Puri, Sameer G.; Morse, Kyle W.; Hearns, Krystle A.; Althann, Caroline von; Carlson, Michelle G.

doi:10.1016/j.jhsa.2015.10.024

Cited by 20 publications

(19 citation statements)

References 13 publications

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“…We observed a high prevalence of ECU tendon (sub)luxation (44%), which is even higher than reported by a recent study in 123 asymptomatic adults that observed 30% of ECU tendon (sub)luxation [35]. Mild ECU tendon subluxation is frequently observed in the supinated wrist; however, rupture of the ECU subsheath is considered to cause greater subluxation in supination [36]. In the present study, 51% of the wrists were scanned in a supinated position.…”

Section: Discussioncontrasting

confidence: 63%

The triangular fibrocartilage complex on high-resolution 3 T MRI in healthy adolescents: the thin line between asymptomatic findings and pathology

et al. 2021

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Objective The objective of the study is to provide a reference for morphology, homogeneity, and signal intensity of triangular fibrocartilage complex (TFCC) and TFCC-related MRI features in adolescents. Materials and methods Prospectively collected data on asymptomatic participants aged 12–18 years, between June 2015 and November 2017, were retrospectively analyzed. A radiograph was performed in all participants to determine skeletal age and ulnar variance. A 3-T MRI followed to assess TFCC components and TFCC-related features. A standardized scoring form, based on MRI definitions used in literature on adults, was used for individual assessment of all participants by four observers. Results per item were expressed as frequencies (percentages) of observations by all observers for all participants combined (n = 92). Inter-observer agreement was determined by the unweighted Fleiss’ kappa with 95% confidence intervals (95% CI). Results The cohort consisted of 23 asymptomatic adolescents (12 girls and 11 boys). Median age was 13.5 years (range 12.0–17.0). Median ulnar variance was −0.7 mm (range − 2.7–1.4). Median triangular fibrocartilage (TFC) thickness was 1.4 mm (range 0.1–2.9). Diffuse increased TFC signal intensity not reaching the articular surface was observed in 30 (33%) observations and a vertical linear increased signal intensity with TFC discontinuation in 19 (20%) observations. Discontinuation between the volar radioulnar ligament and the TFC in the sagittal plane was seen in 23 (25%) observations. The extensor carpi ulnaris was completely dislocated in 10 (11%) observations, more frequent in supinated wrists (p = 0.031). Inter-observer agreement ranged from poor to fair for scoring items on the individual TFCC components. Conclusion MRI findings, whether normal variation or asymptomatic abnormality, can be observed in TFCC and TFCC-related features of asymptomatic adolescents. The rather low inter-observer agreement underscores the challenges in interpreting these small structures on MRI. This should be taken into consideration when interpreting clinical MRIs and deciding upon arthroscopy.

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Section: Discussioncontrasting

confidence: 63%

The triangular fibrocartilage complex on high-resolution 3 T MRI in healthy adolescents: the thin line between asymptomatic findings and pathology

et al. 2021

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“…The extensor retinaculum, which passes over the ECU tendon, has no retaining function [46]. Tendon instability results from chronic subsheath overuse or sudden rotational movement, as seen, for example, during backhand tennis swings (supinated forearm, wrist in flexion, and ulnar deviation) [47].…”

Section: Instability Of the Ecu Tendonmentioning

confidence: 99%

Tendons and Tendon Sheaths of the Hand – An Update on MRI

Schmitt

Hesse

Grunz

2022

Rofo

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Background The tendons of the hand run in close proximity to each other and within retinacular tunnels adjacent to articular joints, while forming intersections in characteristic locations. The enclosing tendon sheaths are often sites of systemic or infectious inflammation. Method This review article outlines the different entities of tendon and tendon sheath pathology and their manifestation in the hands. Diagnostic findings in tendon and tendon sheath disorders are illustrated using MRI imaging and discussed in context with the current literature. Results and Conclusion Overuse may cause stenosis in the fibrous outer layer of the retinacula and the A1 annular ligaments as well as tendinosis. In contrast, proliferative tenosynovitis is a disease of the synovial inner layer of the tendon sheath with tendon infiltration and tendinitis. Pyogenic tenosynovitis favors the flexor compartments. Because of the narrow spaces in the hand, a high-resolution MRI technique must be used. Key Points: Citation Format

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“…Graham (2012) reported increased intrinsic ECU tendon wear and ulna fractures or suture anchor failure following osseous groove deepening. In addition, the importance of ECU groove depth in the native ECU tendon is unclear as Ghatan et al (2016) found no relationship between groove depth and tendon subluxation in cadaveric studies. Nonetheless favourable outcomes are Table 1.…”

Section: Discussionmentioning

confidence: 97%

Surgical transposition for chronic instability of the extensor carpi ulnaris tendon

Fram

Wall

Gelberman

et al. 2018

J Hand Surg Eur Vol

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Painful extensor carpi ulnaris tendon instability has various treatments with limited available outcome data. We treated 12 wrists of 11 patients (including eight collegiate or professional athletes) with dorsal transposition of the extensor carpi ulnaris tendon to lie over the 5th compartment, stabilized with a retinacular sling from 2010-2015. All patients had symptom resolution and returned to sport at the pre-injury level by 3 months after surgery. Mean post-surgical Patient Reported Outcomes Measurement Information System (PROMIS) upper extremity score was 56, and PROMIS pain interference score was 42. Patient overall satisfaction averaged 9.8 points on a 10-point scale for the procedure and pain decreased by 6 points on a 10-point scale from before surgery to final follow-up. We conclude that surgical treatment of the extensor carpi ulnaris tendon instability via dorsal transposition of the extensor carpi ulnaris tendon is an effective surgical option for all patients including the high level athlete. Level of evidence: IV.

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Relative Contribution of the Subsheath to Extensor Carpi Ulnaris Tendon Stability: Implications for Surgical Reconstruction and Rehabilitation

Cited by 20 publications

References 13 publications

The triangular fibrocartilage complex on high-resolution 3 T MRI in healthy adolescents: the thin line between asymptomatic findings and pathology

The triangular fibrocartilage complex on high-resolution 3 T MRI in healthy adolescents: the thin line between asymptomatic findings and pathology

Tendons and Tendon Sheaths of the Hand – An Update on MRI

Surgical transposition for chronic instability of the extensor carpi ulnaris tendon

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