Extensor Carpi Ulnaris Sheath Research Articles

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.

Anatomy and Clinical Relevance of the Ulnocarpal Ligament

Anatomy and Clinical Relevance of the Ulnocarpal Ligament

Subluxation of the Extensor Carpi Ulnaris Tendon Associated with the Extensor Digitorum Tendon Subluxation of the Long Finger

A twenty-year-old male visited our clinic with wrist and long finger metacarpophalangeal (MP) joint pain. Dynamic ultrasonography revealed sagittal band (SB) ulnar subluxation and extensor carpi ulnaris (ECU) volar subluxation. Magnetic resonance imaging showed longitudinal splitting and dislocation of the volar half slip of the ECU tendon. The redundant radial SB was augmented and ECU sheath was advanced to the periosteum using suture anchors. He was able to perform his previous activities at the last follow-up. We encountered a case of "simulateous" ECU dislocation with extensor tendon subluxation of the long finger at the MP joint. Therefore, we report this case with a review of the relevant literature.

The ECU Synergy Test: An Aid to Diagnose ECU Tendonitis

Chronic dorsal ulnar-sided wrist pain challenges even the most experienced physicians. The close anatomic proximity and the possibility of coexistent injuries can render physical examination maneuvers ambiguous, making it difficult to discern between intra-articular and extra-articular pathology. Using the principle of synergism, we describe the extensor carpi ulnaris (ECU) synergy test as a novel means for diagnosing ECU tendonitis and document its benefit in the clinical setting. A retrospective chart review was performed, identifying adult patients experiencing greater than 4 months of dorsal ulnar-sided wrist pain. Physical examination findings, results of magnetic resonance imaging (MRI) and/or wrist arthroscopy, and clinical outcomes were compiled. Fifty-five patients met inclusion criteria. Twenty-one patients (group 1) had no pain with the synergy test but had exams suggesting ulnar-sided intra-articular pathology. All had ulnar-sided intra-articular pathology on MRI and/or arthroscopy. Eleven patients (group 2) had positive synergy tests and no pain with the remainder of the exam. All had greater than 90% pain relief after ECU tendon sheath injection; 5 patients remained pain free. Six patients experienced temporary improvement and had MRI evaluation, confirming the diagnosis of isolated ECU tendonitis in 5 of the 6 patients. The remaining 22 patients (group 3) had positive synergy tests and exams that suggested concomitant ulnar-sided intra-articular pathology. After ECU sheath injection, 5 patients had persistent discomfort with either lunotriquetral ballottement or triangular fibrocartilage complex compression. All 5 patients had ulnar-sided intra-articular pathology confirmed by MRI and/or arthroscopy. Seventeen patients had greater than 90% pain relief after injection. Of these, 7 patients remained asymptomatic at latest follow-up, confirming the diagnosis of ECU tendonitis. Ten patients had recurrent symptoms, of which 6 patients demonstrated ulnocarpal pathology by MRI and/or wrist arthroscopy. By differentiating between intra-articular and extra-articular pathology, the ECU synergy test composes part of a clinical algorithm that minimizes the need for wrist MRI and diagnostic arthroscopy. Diagnostic II.

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.

Kinematic analysis of the distal radioulnar joint after a simulated progressive ulnar-sided wrist injury.

A kinematic analysis of a progressive, ulnar-sided wrist injury was performed using a cadaver model to study the static and dynamic stabilizers of the distal radioulnar joint with a 3-dimensional motion tracking system. Anatomically based loads were applied to achieve pronation and supination and then the specimens were evaluated after serial transection of the triangular fibrocartilage, the extensor carpi ulnaris sheath, and the ulnocarpal ligaments. Statistically significant increases in translation of the radius relative to the ulna occurred with sectioning of both the triangular fibrocartilage proper and the extensor carpi ulnaris tendon sheath. No significant change in position of the forearm could be appreciated with subsequent sectioning of the ulnocarpal ligaments. Our observations support the idea that the ulnocarpal ligaments do not need to be surgically reconstructed when there are serious injuries to the triangular fibrocartilage complex.

Complications Following Distal Radial Fractures

Union with deformity is the most common complication following a distal radial fracture1-5. The deformity may be extra-articular, characterized by loss of length and metaphyseal angulation; it may be intra-articular, involving either the radiocarpal or the radioulnar joint, or both; or it may be a combination of the two. Surgical treatment of a symptomatic malunion of the distal part of the radius has been recognized for more than 200 years. Resection of the distal aspect of the ulna for the management of pain at the distal radioulnar joint after a distal radial fracture, a procedure attributed to Darrach after his description in 19136, had been suggested by Desault in 17917 and again by Moore in 18808. In 1937, Campbell described a corrective osteotomy of the distal part of the radius with use of an interpositional bone graft obtained from the distal part of the ulna9. In 1945, Merle d’Aubigne and Joussement described a multiple-facet curved osteotomy without the need for an interpositional bone graft10. This concept is currently being revisited and will be described. A deformity following fracture of the distal part of the radius is not necessarily symptomatic. In fact, it is not uncommon for an older patient to have acceptable wrist and forearm function without pain even when there is an apparent deformity. Therefore, impairment of function rather than radiographic deformity is the reason to treat a distal radial malunion, and, consequently, the patient’s wrist and forearm function must be assessed. The most common deformity following a malunited extra-articular Colles type of fracture is the loss of the normal volar tilt of the articular surface in the sagittal plane, loss of ulnar inclination in the frontal plane, loss of length relative to the ulna, and …

Experimentally induced ulno-carpal instability: A study on 13 cadaver wrists

This experimental work studies the role of ligamentous structures in suspending the carpal bones from the radius and ulna. Thirteen human cadaver wrists underwent a distal radio-ulnar arthrodesis in a neutral position and an arthrodesis between the three bones of the first carpal row. Progressive postero-anterior forces in a palmar direction were applied to the fused carpal bones. Displacement was measured by two dial gauges before and after sequential section of the different fibrous structures. The largest absolute average displacement (both, dorso-palmar and induced rotational displacement) was observed after section of the ulnar styloid process. No significant differences were observed after section of the extensor retinaculum, extensor carpi ulnaris sheath, posterior ulno-carpal and posterior radio-carpal ligaments. This work suggests that the carpus is suspended not only from the radius, but also from the distal ulna and particularly at the ulnar styloid and the structures which insert onto it.

Stenosing tenovaginitis of extensor carpi ulnaris: brief report.

Since 1895, when de Quervain first described stenosing tenovaginitis of the tendons of abductor pollicis longus and extensor pollicis brevis at the radial styloid, a number of similar lesions have been described around the wrist joint. The tendons involved include extensor digiti minimi (Drury 1955), extensor carpi ulnaris (Dickson and Luckey 1948), flexor carpi radialis (Fitton, Shea and Goldie 1968) and extensor indicis proprius (Ritter and Inglis 1969). The only published report on tenovaginitis of extensor carpi ulnaris indicates that this is rare and is usually precipitated by a twisting injury. We have collected 72 cases which demonstrate that the incidence of this condition is quite high; awareness of the possibility is clearly important. Patients and methods. Of our 72 patients treated over a five-year period 26 were men and 46 women. Seven patients had bilateral involvement, so a total of 79 wrists were treated. Patient’s ages ranged from 20 to 50 years, and they came from a wide range of occupations and social levels. They all presented with pain over the ulnar aspect of the wrist, aggravated by movement of the wrist and exertion. None gave a history of trauma or twisting injury and none had any associated disease. On examination, a firm fusiform swelling was present on the dorso-ulnar aspect of the wrist, usually extending from about 1 cm proximal to the ulnar styloid to the carpus (Fig. 1). There was no local warmth, but some tenderness over the swelling. Pain was elicited when the clenched fist was forced into radial deviation and when active ulnar deviation was attempted against resistance. Radiographs were normal in all cases. Treatment. All 72 patients had a trial of local infiltration with hydrocortisone acetate, but only nine patients obtained complete relief. The remaining 63 failed to respond, and had an operation some four to five weeks later. At operation, under either regional block or general anaesthesia, a lazy S longitudinal incision was made over the head and styloid process of the ulna, care being taken to protect the dorsal branch of the ulnar nerve. The thickened sheath of extensor carpi ulnaris was excised and the tendon freed completely. The wound was closed