Extensor Carpi Ulnaris Tendon Subluxation Research Articles

Extensor Carpi Ulnaris Subluxation.

Extensor carpi ulnaris tendon subluxation can be a challenging diagnosis as a cause of wrist pain. The tendon is stabilized by a tough subsheath. This subsheath is vulnerable to tears in acute wrist movements, especially those combining supination, flexion, and ulnar deviation. The patient presenting acutely may experience swelling, tenderness, and pain. In a chronic setting, the complaint is often an unstable wrist. The diagnosis can be made with a thorough examination, and ultrasonography can be used to evaluate the dynamics of the tendon. Surgical repair with a flap of extensor retinaculum to re-create the tendon's stabilizing subsheath is recommended.

Ulnar-Sided Traumatic Wrist Pain. High Resolution Ultrasound Effectiveness versus MRI Assessment and Accuracy

Abstract Background: This work was conducted to assess the effectiveness of high resolution Ultrasonography (USG) compared with Magnetic Resonance Imaging (MRI) in inves-tigating causes of ulnar sided wrist pain in traumatic patients, as this entity represents a diagnostic dilemma, owing to the anatomical complexity and small sized structures, as well as diversity of causes. Imaging plays an important role in guiding the diagnosis and minimizing unwanted surgical interventions. Aim of Study: To evaluate the diagnostic performance of both ultrasonography and MRI in ulnar sided wrist pain, high-lightening both the strengths and weaknesses of these two imaging modalities. Patients and Methods: This study included fifty patients presenting with ulnar sided wrist pain. MRI and Ultrasonog-raphy were done in all patients. Results: Out of 50 patients, 30 males (60%) and 20 females (40%), age ranging 23-65 years, were included in this study. A comparative analysis was done using MRI versus USG findings. The sensitivity, specificity, and accuracy of USG for Scapho-lunate ligament injury were 45.5%, 100%, 88% respectively, as MRI was positive in 11 cases, while USG only diagnosed 5 cases. The sensitivity, specificity, and accuracy for Triangular Fibrocartilage (TFCC) tear, were 64.71%, 90.91% and 82% respectively, as MRI was positive in 17 cases, while USG diagnosed 14 cases. For Extensor Carpi Ulnaris (ECU) injury, were 100%, 89.1% and 92% respectively, as MRI was positive in 13 cases, while USG diagnosed 17 cases. For extensor carpi ulnaris tendon sublux-ation, were 100%, 100% and 100% respectively, as both modalities were successful in diagnosing the same three cases, for ganglion cysts, were 100%, 100% and 100% respectively. For trabecular bone edema, MRI was positive in 24 cases, and for distal radioulnar joint instability MRI was positive in 9 cases, which were not diagnosed by USG, with lack of agreement between both modalities. Conclusion: Both magnetic resonance imaging and mus-culoskeletal ultrasound are essential and complement each other in the evaluation of causes of ulnar sided wrist pain in trauma patients. Musculoskeletal ultrasound is highly recom-mended for the examination of tendon injuries, while MRI is more efficient and suitable for assessing deeper structures, such as bone or ligaments.

ECU tendon subluxation: A nonspecific MRI finding occurring in all wrist positions irrespective of ulnar-sided symptoms?

BackgroundRecurrent subluxation or dislocation of the extensor carpi ulnaris (ECU) tendon from the ulnar groove is an important cause of ulnar-sided wrist pain. Demonstration of ECU subluxation on MRI is of unclear clinical significance. Previous studies have suggested wrist positioning can affect the ECU's position relative to the ulnar groove. This study evaluates the relationship between ECU subluxation and wrist positioning on MRI, and separately their association with ulnar-sided symptoms. Methods161 wrist MRI scans of 141 patients from four hospitals were retrospectively evaluated for wrist position (defined by radio-ulnar angle), degree of ECU subluxation and the presence of ulnar-sided symptoms and MRI abnormalities. 30 scans were scored by two different raters to assess interrater reliability. A linear regression model was constructed to assess the relation between wrist positioning and subluxation, accounting for other variables. A logistic regression model was constructed to evaluate which variables are predictive of ulnar-sided symptoms. ResultsECU subluxation was neither significantly correlated to wrist position (p = 0.338) nor predictive of the presence of ulnar-sided symptoms (odds ratio 1.28, 95% CI 0.39–4.18). ECU position varied widely for all wrist positions and subluxation occurred in all wrist positions, both in symptomatic and asymptomatic subjects. No trend was observed towards more frequent subluxation in supination, contrary to previous studies. Interrater reliability for radioulnar angle and ECU displacement was excellent (intraclass correlation coefficient for consistency 0.993 and 0.943, respectively). ConclusionECU subluxation occurs frequently in all wrist positions, irrespective of ulnar-sided symptoms, and is not associated with ulnar-sided symptoms.

Diagnosing extensor carpi ulnaris tendon dislocation with dynamic rotation MRI of the wrist

ObjectiveThe purpose of this study was to retrospectively correlate the kinematic dynamic rotation MRI (DR-MRI) of the wrist for assessment of extensor carpi ulnaris (ECU) tendon subluxation and dislocation. Material and methodsThe presence of an ECU tendon subluxation or dislocation on the DR-MRI report was correlated to findings of the surgical report. ResultsDR-MRI findings showed an ECU subluxation in 12 cases and an ECU dislocation in 13 cases. Surgery showed an ECU subluxation in 13 cases and an ECU dislocation in 12 cases (ĸ = 0.92). ConclusionDR-MRI is a feasible method to visualize ECU tendon subluxation and dislocation.

Ulnar-sided Wrist pain due to Extensor Carpi Ulnaris tendon subluxation: A case report

Traumatic Extensor Carpi Ulnaris (ECU) sublaxation is often missed and undiagnosed or wrongly diagnosed. ECU muscle plays a key role in active movement of wrist extension, ulnar deviation and also in providing suport to the ulnar side of wrist. Its position relative to the other structures in the wrist changes with forearm pronation and supination. As such it must be mobile yet stable. This structure can be injured in a variety of different athletic activity and following fall on outstretched hand. It lies subcutaneously and easily palpated and visualized, allowing early diagnosis and management. We in our study report a case of traumatic ECU sublaxation. An 18 year old female patient presented to our OPD with ulnar side wrist pain. MRI showed volar subluxed ECU tendon with ruptured ECU sheath. We had done open ECU sheath repair and excision of bursa. Very few literature shows traumatic ECU sublaxation report. The case is reported for the rarity of presentation and likely to misdiagnose in day to day clinical scenario.

Wrist Pain due to Abnormal Extensor Carpi Ulnaris Tendon.

Pain arising from lesions in the extensor carpi ulnaris (ECU) is known to occur mainly due to tenosynovitis, tendon rupture, and subluxation or dislocation of the ECU tendon [1,2]. However, anomalies of the ECU tendon itself and the surrounding extensor retinaculum are also possible factors contributing to the impairment of function at the dorso-ulnar aspect of the wrist and little finger [2,3]. We report a case in which an abnormal ECU tendon slip was revealed during exploration of the wrist. A 28-year-old right-handed female neurosurgeon visited our clinic due to dorso-ulnar wrist pain in her dominant hand for six months. The pain was exacerbated during wrist motion, especially during forearm supination for handling the needle holders in the operating field. A physical examination revealed no sensory changes and no specific signs, including the Phalen and Finkelstein tests. Radiographic studies also showed no problems such as joint subluxation. The hand showed a slight tender swelling of the ECU tendon around the wrist. With the suspicion of tenosynovitis, steroid injection into the sixth compartment was performed. However, the pain did not respond to medical treatment. Electrodiagnostic studies revealed no abnormalities. On exploration, we found the abnormal insertion of an additional ECU tendon slip into the radial inner side of the sixth compartment (Fig. 1). After simple excision of the entire abnormal ECU tendon slip, her symptoms improved. Fig. 1 The abnormal insertion of an additional extensor carpi ulnaris (ECU) tendon slip into the radial inner side of the sixth compartment. The ECU tendon is enclosed in the sixth compartment of the extensor retinaculum and various anomalies of the ECU tendon have been reported [2,3]. The prevalence of an accessory tendinous slip arising from the ECU tendon has been reported to be 10% to 34% [2,4], and Barfred and Adamsen [3] noted that the accessory tendinous slip of the ECU was sometimes connected with the extensor digiti minimi. Nakashima classified accessory slips into three types according to the insertion point of the main tendon to the fifth metacarpal bone: type A, on the base along with the main tendon; type B, on the midsection; and type C, on the head [2]. The case presented here belonged to type A. The average width of the slips has been reported to range from 1–1.53 mm [2,3], while the presented case showed a slip 1.5 mm in width and 2 cm in length. Taleisnik et al. [5] observed that the transverse fibers of the medial wall of the sixth compartment extend proximally to become confluent with the epimysium of the ECU, and are reinforced by the linea jugata, which normally prevents ECU tendon subluxation during full supination. Since the ECU tendon is exposed to maximal traction when the forearm is supinated, we believe that her wrist pain was induced by repetitive and excessive supination-pronation activity, which might otherwise remain non-symptomatic given usual movement patterns. Anatomical variations of the ECU may affect diagnostic and surgical procedures involving the dorso-ulnar aspect of the wrist. During surgery performed on the ECU, the surgeon must be aware of the possible existence of an accessory tendinous slip that may cause ECU lesions to persist.

Tendinopathies of the Extensor Carpi Ulnaris.

To improve its mechanical advantage, the extensor carpi ulnaris (ECU) muscle uses, as if it was a pulley, the 6(th) extensor compartment, a dorsal fibro-osseous tunnel formed by the ulnar sulcus and the ECU tendon sub-sheath. Rupture or insufficiency of that sheath may allow anteromedial ECU tendon subluxation and subsequent destabilization of the distal radioulnar and ulnocarpal joints. Sometimes, it is not sheath problem, but excessive friction between the sheath and the tendon what causes a painful degeneration of the tendon (tendinosis) with or without tendon entrapment. The term "ECU tendinopathy" has been chosen to designate all painful ECU anomalies resulting from a dysfunctional 6(th) extensor compartment. ECU tendinopathies are frequent among sportsmen using bats, sticks or clubs. There are 2 major types of tendinopathy: 1) constrained tendinopathies, where there is entrapment of a thickened overused tendon, and 2) unconstrained tendinopathies, where a ruptured ECU sub-sheath allows the ECU to sublux in a volar direction, a position precluding all its stabilizing potential. In the first type, the goal of the treatment is to avoid further degeneration and subsequent rupture of the diseased tendon; in the second, to re-establish the normal connections between the ulna and the ECU tendon. This article reviews the management of the most frequent ECU tendinopathies.

Wrist Pain in a Tennis Player

HISTORY: A 19 year-old male Division I tennis player developed atraumatic left wrist pain, worsening over 2.5 weeks. His pain was located at the ulnar aspect of his wrist and radiated proximally along his forearm. The pain was exacerbated by ulnar deviation during his backhand swing. He initially denied mechanical symptoms, including clicking and snapping, as well denying any numbness and tingling. His pain did not improve with physical therapy over one month, at which time he presented with new onset of clicking at the ulnar aspect of his wrist during ulnar deviation. PHYSICAL EXAMINATION: Initial examination revealed no swelling or deformities. He had no tenderness to palpation. He exhibited full range of motion and strength, equal to the opposite side. Ulnar deviation reproduced pain at the ulnar aspect of the wrist. At his follow up visit, the patient exhibited focal tenderness along the extensor carpi ulnaris tendon and subluxation of the tendon was visualized and palpated during active supination of the forearm. DIFFERENTIAL DIAGNOSIS: 1. Extensor carpi ulnaris tendon subluxation 2. Extensor carpi ulnaris tendinopathy and/or tenosynovitis 3. Extensor carpi ulnaris tendon partial tear 4. Triangular fibrocartilage complex tear TEST AND RESULTS: Left wrist radiographs: - No evidence of fracture or dislocation Left wrist ultrasound (performed prior to development snapping): - Extensor carpi ulnaris tendon intact with normal morphologic appearance, overall normal wrist ultrasound Left wrist MRI (performed prior to development snapping): - Mild extensor carpi ulnaris tendinopathy and peritendonitis, no subluxation FINAL WORKING DIAGNOSIS: Extensor carpi ulnaris subluxation TREATMENT AND OUTCOMES: 1. Due to the development of new subluxation and failed improvement with conservative treatment, the patient elected for surgical intervention of the tendon subluxation following development of mechanical symptoms and considering that he was an in-season athlete. 2. The patient underwent successful surgical reconstruction of the extensor compartment. A sample of soft tissue confirmed chronic tenosynovitis. 3. The patient was casted for three weeks, followed by rehabilitation and return to play 3 months later.

Association between distal ulnar morphology and extensor carpi ulnaris tendon pathology

The purpose of this study was to evaluate the association between distal ulnar morphology and extensor carpi ulnaris (ECU) tendon pathology. We retrospectively reviewed 71 adult wrist MRI studies with ECU tendon pathology (tenosynovitis, tendinopathy, or tear), and/or ECU subluxation. Subjects did not have a history of trauma, surgery, infection, or inflammatory arthritis. MRI studies from 46 subjects without ECU tendon pathology or subluxation were used as controls. The following morphological parameters of the distal ulna were measured independently by two readers: ulnar variance relative to radius, ulnar styloid process length, ECU groove depth and length. Subjects and controls were compared using Student's t test. Inter-observer agreement (ICC) was calculated. There was a significant correlation between negative ulnar variance and ECU tendon pathology (reader 1 [R1], P = 0.01; reader 2 [R2], P < 0.0001; R1 and R2 averaged data, P < 0.0001) and ECU tendon subluxation (P = 0.001; P = 0.0001; P < 0.0001). In subjects with ECU tendon subluxation there was also a trend toward a shorter length (P = 0.3; P <0.0001; P = 0.001) and a shallower ECU groove (P = 0.01; P = 0.03; P = 0.01; R1 and R2 averaged data with Bonferroni correction, P = 0.08). ECU groove depth (P = 0.6; P = 0.8; P = 0.9) and groove length (P = 0.1; P = 0.4; P = 0.7) showed no significant correlation with ECU tendon pathology, and length of the ulnar styloid process showed no significant correlation with ECU tendon pathology (P = 0.2; P = 0.3; P = 0.2) or subluxation (P = 0.4; P = 0.5; P = 0.5). Inter-observer agreement (ICC) was >0.64 for all parameters. Distal ulnar morphology may be associated with ECU tendon abnormalities.

The prevalence, variety and impact of wrist problems in elite professional golfers on the European Tour

ObjectivesGolf is a popular sport played by an estimated 57 million people. Previous studies on wrist injuries in elite golfers have been of simple design and have demonstrated such injuries...

Ulnar-sided pain due to extensor carpi ulnaris tendon subluxation: a case report.

IntroductionWe present the case of a patient with extensor carpi ulnaris tendon subluxation who was first treated for distal radioulnar joint sprain.Case presentationA 25-year-old Caucasian man was seen at our policlinic one month after he had fallen on his outstretched hand. A diagnosis of extensor carpi ulnaris subluxation was made clinically but we also had the magnetic resonance imaging scan of the patient’s wrist which displayed an increased signal on T2-weighted images consistent with inflammation around the extensor carpi ulnaris tendon. The extensor carpi ulnaris tendon was found to be dislocating during supination and relocating during pronation. The sheath was reconstructed using extensor retinaculum due to attenuation of subsheath.ConclusionThere was no recurrent dislocation of the extensor carpi ulnaris tendon of the patient at his last follow up 12 months after the operation.

Conservative Treatment of an Acute Traumatic Extensor Carpi Ulnaris Tendon Subluxation in a Collegiate Basketball Player: A Case Report

To present the case of an acute traumatic extensor carpi ulnaris (ECU) subluxation in a National Collegiate Athletic Association Division II female basketball player. The ECU tendon is stabilized in the ulnar groove by a subsheath located inferior to the extensor retinaculum. The subsheath can be injured with forced supination, ulnar deviation, and wrist flexion, resulting in the ECU tendon subluxing in the palmar and ulnar directions during wrist circumduction. Several methods of intervention exist, but controversy remains on how to best treat this condition. Distal ulnar fracture, ulnar collateral ligament sprain, triangular fibrocartilage complex lesion, lunotriquetral instability, distal radioulnar joint injury, pisotriquetral joint injury, ECU tendinopathy or subluxation. The wrist was placed in a short-arm cast in slight extension and radial deviation for 4 weeks. At that time, the patient was still able to actively sublux the ECU tendon, so a long-arm cast was applied with the wrist in slight extension, radial deviation, and pronation for an additional 4 weeks. The ECU tendon was then found to be stable. She wore a rigid wrist brace for 3 more weeks while she pursued rehabilitation. At the final follow-up appointment, the ECU tendon remained stable, and the wrist was asymptomatic. Subluxations of the ECU are rare. If the patient does not improve with conservative measures, surgical intervention is warranted to repair the sixth dorsal compartment. A long-arm cast with the elbow flexed to 90° and the wrist in approximately 30° of extension, radial deviation, and pronation was appropriate treatment for this type of injury.

Diagnosis and Anatomic Reconstruction of Extensor Carpi Ulnaris Subluxation

To evaluate the efficacy of dynamic ultrasound to diagnose extensor carpi ulnaris (ECU) subluxation and assess the results of a new technique for anatomic ECU tendon sheath reconstruction. Dynamic ultrasound was used to confirm the diagnosis of ECU tendon subluxation in patients presenting with painful snapping of the ulnar wrist during supination and pronation. Twenty-one patients with persistent subluxation had reconstruction of the ECU tendon sheath using a new technique. In this procedure, the ECU tendon is elevated within its sheath dorsally and radially. The distal ulnar groove is deepened with a power burr, and 2 or 3 suture anchors are placed along the ulnar margin of the reconstructed groove. The sutures are passed through the ulnar border of the ECU sheath and tied, securing tendon sheath to bone. Preoperative wrist flexion-extension, radial-ulnar deviation, pronation-supination, grip strength, and ratings of pain, satisfaction, and Disabilities of the Arm, Shoulder, and Hand (DASH) scores were recorded and compared with postoperative values in a prospective study. Fourteen male patients and seven female patients were followed from 24 to 45 months postoperatively (mean, 31 mo). Twenty-one patients presented with symptomatic ECU tendon subluxation confirmed by dynamic ultrasound of the wrist. We noted a statistically significant increase in arc of wrist flexion-extension, radial-ulnar deviation, pronation-supination, and grip strength after reconstruction. There was a statistically significant improvement in pain, satisfaction, and DASH scores after ECU stabilization. Dynamic ultrasound is an effective and noninvasive method of diagnosing ECU tendon subluxation. Our technique of anatomic ECU tendon sheath reconstruction improved postoperative wrist range of motion, grip strength, pain, satisfaction, and DASH scores. Therapeutic IV.

Recurrent dislocation of extensor carpi ulnaris tendon

Four cases of symptomatic extensor carpi ulnaris tendon subluxation secondary to extensor carpi ulnaris tendon sheath attenuation of the wrist are presented in an attempt to provide greater awareness of this frequently undiagnosed clinical entity. Sheath reconstruction has been successful in relieving symptoms.