Dr. Mark E. Pruzansky
Dr. Jason S. Pruzansky
975 Park Avenue New York, NY 10028

Extensor Carpi Ulnaris Tendinitis (ECU Tendinitis)

What is Extensor Carpi Ulnaris Tendinitis?

Extensor carpi ulnaris tendinitis is an injury of the wrist where the extensor carpi ulnaris muscle becomes inflamed and irritated. This muscle extends from the outer portion of the forearm and attaches to the fifth metacarpal, functioning to extend the wrist towards the pinky. Continual repetitive movements that places stress on the tendon of this muscle, often leads pain, irritation, and eventually extensor carpi ulnaris tendinitis.

ECU Tendinitis is a condition common among people who play racquet sports or basketball. Baseball pitchers may suffer from this when their throwing mechanics are deficient.

Characteristics and Clinical Presentation of Extensor Carpi Ulnaris Tendinitis?

Any repetitive action from a non-ergonomically correct position that entails twisting or backward flexing of the wrist—like returning a tennis ball or shooting a basket—can put strain on the ECU tendon to the point of tenderness, pain and actual tearing. Malposition of the hand while using a mouse or computer keyboard may also be a contributing factor.

The most common symptom of this condition is pain on the ulnar side of the wrist, increasing with use of the hand during daily operations. Bending or grabbing with the wrist increases this discomfort. Patients often report a “popping” sound when using the wrist. Other symptoms may include:

  • Swelling
  • Stiffness
  • Weakness
  • Decreased range of motion

Getting a Diagnosis for Extensor Carpi Ulnaris Tendinitis?

This injury most often requires imaging for a diagnosis. These imaging tests include an MRI or an ultrasound. All three options allow for visualization of the ligamentous tissue of the wrist. Your hand surgeon will perform a physical examination of the wrist and may ask you to flex your hand and extend your wrist to assess limitations in movement and difficulty moving the affected region.

Treatment Options for Extensor Carpi Ulnaris Tendinitis?

Treatment for extensor carpi ulnaris tendinitis is usually simple, involving rest and treating pain. Mild cases of ECU Tendinitis can be treated with rest, splinting and non-steroidal anti-inflammatories, whereas severe instances can necessitate cortisone injection or surgery to repair the tendon and its sheath which anchors it to the ulna head and wrist (aka subsheath).

Conservative Treatments

Conservative methods include immobilization and stabilization of the affected wrist by placing it in a cast or splint. Some patients may require a long arm fiberglass cast to try to ensure that all wrist movement is completely stopped. Some patients may benefit from a corticosteroid injection to relieve pain and swelling, alongside NSAID pain management.

Surgical Treatments

In the event that this injury does not improve with conservative management, or if the injury is deemed too severe after an initial analysis, surgical intervention may be required. Surgical repair of the ECU is not often required, however, a severe injury may indicate the need for its reconstruction. An experienced hand surgeon, like Drs. Pruzansky, will have the knowledge required to make this judgement call. It is extremely important to see a medical professional at the time of injury or as soon as you know that you have one for the best possible diagnosis.

Preventing Extensor Carpi Ulnaris Tendinitis?

Some injuries may be unavoidable, however, utilizing proper body mechanics during athletic activities is extremely important. Additionally, making use of safety equipment during gameplay or wearing a brace on your wrist if it has been injured in the past can help prevent future injury. Players should cease athletic activities at the first sign of pain or discomfort and consult with a medical professional. Often times, allowing the wrist to rest between gameplay and icing the affected region can aide in minimizing long-term wear and tear.

Prognosis for Extensor Carpi Ulnaris Tendinitis?

Many patients benefit from a period of rest following an injury to the extensor carpi ulnaris muscle. Your doctor may recommend a period of immobilization for 2-4 weeks following an injury. Surgical intervention may require a healing period of 6-8 weeks, followed by physical therapy. Many patients can look forward to a full recovery with full range of motion following proper medical intervention and attention to the injury.

If You Believe You Have Extensor Carpi Ulnaris Tendinitis, 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.