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What are Extensor Carpi Ulnaris (ECU) Subsheath Tears?

Extensor Carpi Ulnaris Subsheath Tears are a fairly common injury involving people who play golf, contact, and racket sports. As an injury on the pinky side of the wrist, the extensor carpi ulnaris subsheath becomes torn with sudden, forceful or repetitive rotational movements of the wrist while engaging in sports, though it is more likely to happen in professional athletes, it commonly occurs in weekend athletes, or just when someone falls.

The ECU muscle plays an active role in movements of wrist extension and ulnar deviation. It also provides stability to the ulnar side of the wrist. It relies on specific stabilization structures to be held in its correct position to perform different daily functions.

When an individual experiences an ECU subsheath tear, they may become more prone to further injury of the wrist and may have sustained additional damage that often occurs during the same injury. That is why it is so important for individuals to seek medical attention when they notice discomfort, particularly with wrist rotation.

Characteristics and Clinical Presentation of Extensor Carpi Ulnaris (ECU) Subsheath Tears

Ulnar side wrist pain is a common complaint among patients with this injury and is generally demonstrable during the history and physical process. MR imaging is often able to detect this and other ulnar sided abnormalities and tears.

Common symptoms indicative of an extensor carpi ulnaris (ECU) subsheath tear may include:

  • Swelling and discomfort
  • Stiffness
  • Snapping or clicking with rotation
  • Decreased range of motion

Causes of Extensor Carpi Ulnaris (ECU) Subsheath Tears

Most commonly, patients may develop this injury through a hard twist or forceful repetitive twists  of the wrist. I may be intensified by repeated impact to the wrist during racket sports or golf, can irritate this ligament and cause this condition to develop.

The ECU tendon and its vital, retaining subsheath ligament are vulnerable due to its position subcutaneously. However, it may also be visualized during diagnostic ultrasounds, which allows for early diagnosis.

Getting a Diagnosis for Extensor Carpi Ulnaris (ECU) Subsheath Tears

Magnetic resonance imaging and ultrasounds are often employed to diagnose or confirm subsheath tears. Due to its subcutaneous position, it is easily visualized, making for quick analysis.

It is important that athletes and individuals alike seek treatment from a highly qualified surgeon, with specialization in treating injuries of the hand and wrist in order to assess if they are getting the proper diagnosis and care.

Treatment Options for Extensor Carpi Ulnaris (ECU) Subsheath Tears

ECU injuries can often be managed conservatively. Splinting and rest with non-steroidal anti-inflammatory medications are typically employed. Local steroid injections may also be beneficial, though they must be used with caution due to an increased risk of tendon and ligament degeneration and tearing.

Keeping the wrist at rest or immobile during the healing stage is vital to long-term recovery from this injury. Degree of damage dictates restrictions.

Conservative Treatments

Conservative treatments are often beneficial for ECU injuries. Immobilization with a splint or cast in extension and radial deviation is a common treatment. This usually sits the tendon back within the ulnar groove.

To try to give a patient the best chance of recovery, activities requiring rotation of the wrist and elbow are limited during this time.

Surgical Treatments

Surgical repair may be recommended in some cases, especially in situations where an individual has an acute or chronic high-grade injury to the ECU. This is important when the subsheath is so torn or stretched that the tendon lies partially or completely outside the ulnar groove. This may best be demonstrated during the physical exam.

ECU tendon tears are repaired at the same time. Uncommon, ruptures are typically repaired using a local graft, primarily the palmaris longus. Reinforcement or reconstruction of the subsheath usies a strip of extensor retinaculum.

This procedure is completed as an outpatient under awake, regional block anesthesia, which allows patients to return home the day of their surgery to continue recovery there.

Preventing Extensor Carpi Ulnaris (ECU) Subsheath Tears

Being mindful of wrist pain during sports activities can prevent extensive damage and tearing of the ECU subsheath. Resting the arm during sports activities can aid in the prevention of substantial tears. It is also important for athletes, or individuals who use a lot of repetitive movements as a part of their job, to learn proper form and techniques to help avoid injury in the long-run.

Prognosis for Extensor Carpi Ulnaris (ECU) Subsheath Tears

Following surgery, the wrist is immobilized in extension for 4-6 weeks to promote healing. Physical therapy to optimize range of motion and strength is recommended.

Most patients report restored range of motion and an improvement in pain during daily activities and sports following their procedure.

If You Believe You Have Been Injured, Contact HandSport Surgery Institute.

Please contact us as soon as possible to schedule an appointment with our talented team. People who have been hurt should be evaluated to try and prevent further injury and mobility issues.

If you have been injured, it’s important to be evaluated by a highly skilled professional. Call Drs. Mark and Jason Pruzansky at 212-249-8700 to schedule an appointment and obtain an accurate diagnosis.

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