Ulnar tendon pain can have a number of causes, including ECUtendonitisand ECU tendon subluxation.
ECU stands for theextensor carpi ulnaristendon, one of the major wrist tendons, located on the ulnar side of the wrist, which is the same side as the small finger. The ECU tendon starts on the back of the forearm and crosses the wrist joint directly on the side.
This article discusses the causes, symptoms, and treatment of ECU tendon problems.
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Understanding Wrist Tendons
Tendons are fibrous connective tissue (similar to rope) that attaches muscles to bone.There are a total of six tendons that run through your forearm and control movement in your hands, wrists, and fingers.
The ECU tendon travels along the back forearm, through a groove in the ulna (forearm bone), and attaches to the base of the hand bones. It works with two other tendons to straighten the wrist and move the wrist in the direction of the pinky rather than the thumb.
ECU Tendonitis
ECU tendonitis is the result of inflammation of the ECU tendon. This condition is most common in nonathletes and generally occurs without an obvious cause.Sometimes people with ECU tendonitis have symptoms that occur following a traumatic injury, such as a wristfracture.
Symptoms
ECU tendonitis symptoms may include:
Diagnosis
Tests are generally performed to evaluate for other sources of wrist pain. X-rays would be normal for most patients withtendonitis.Magnetic resonance imaging (MRI) might show some fluid around the tendon.
Treatment
Typical treatments include rest, ice application, anti-inflammatory medications, and the use of a wrist splint. If symptoms persist after these treatments, acortisone injectionmay be helpful.
Seldom is a surgical procedure needed to treat ECU tendonitis, but if symptoms persist despite appropriate management,surgical debridementof the tendon can be considered.
ECU Snapping or Subluxation
Snapping ECU is more likely to occur in sporting activities, such as golf and tennis, and generally follows a traumatic injury, such as awrist fracture.The injury can cause damage to the tendon sheath and allows the tendon to slide out of its normal position. If the ECU tendon is not held in place, it may “snap” over the bone as the wrist is rotated.
Typical ECU subluxation symptoms include:
Subluxation of the ECU tendon may be visible to your healthcare provider when doing the physical examination. Touching and moving the joint may also identify the injury.
Sometimes MRI or ultrasound imaging is used to determine the full extent of the injury to the sheath.
Initial treatment involves splinting or casting the wrist with the tendon in its proper position to immobilize the tendon and allow the sheath to heal.
If immobilizing isn’t effective, surgical reconstruction of the tendon sheath may be required to get the tendon placed in its proper position and then placed in a cast to allow it to heal.
Summary
Two causes of ulna tendon pain are ECU tendonitis and ECU tendon subluxation. These conditions are usually treated with rest, icing, and immobilizing the wrist and tendon. If those treatments don’t work, a cortisone injection (for tendonitis) or surgery may be considered.
If you are experiencing pain in your wrist that doesn’t go away, talk to a healthcare provider who can help you determine the cause of the pain and recommend the best treatment options for you.
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13 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Erpala F, Ozturk T.“Snapping” of the extensor carpi ulnaris tendon in asymptomatic population.BMC Musculoskelet Disord. 2021;22(1):387. doi:10.1186/s12891-021-04271-zPang EQ, Yao J.Ulnar-sided wrist pain in the athlete (TFCC/DRUJ/ECU).Curr Rev Musculoskelet Med. 2017;10(1):53-61. doi:10.1007%2Fs12178-017-9384-9Medline Plus.Tendon vs. ligament.American Society for Surgery of the Hand.Anatomy 101: wrist tendons.American Society for Surgery of the Hand.Tendons.Adams J, Habbu R.Tendinopathies of the hand and wrist.J Am Acad Orthop Surg. 2015;23(12):741-750. doi:10.5435/jaaos-d-14-00216NYU Langone Health.Diagnosing bursitis & tendonitis in adults.Docking SI, Ooi CC, Connell D.Tendinopathy: is imaging telling us the entire story?J Orthop Sports Phys Ther. 2015;45(11):842-852. doi:10.2519/jospt.2015.5880American Academy of Family Physicians.Diagnostic and therapeutic injection of the wrist and hand regions.Erpala F, Ozturk T.“Snapping” of the extensor carpi ulnaris tendon in asymptomatic population.BMC Musculoskelet Disord. 2021;22(1):387. doi: 10.1186/s12891-021-04271-zRios-Russo JL, Lozada-Bado LS, de Mel S, Frontera W, Micheo W.Ulnar-sided wrist pain in the athlete: sport-specific demands, clinical presentation, and management options.Curr Sports Med Rep. 2021;20(6):312-318. doi:10.1249/JSR.0000000000000853Vomer RP 2nd, Lewno AJ, Udoh I, Albano-Aluquin S, Pujalte GGA.Evaluation of the hand and wrist via telephone and video visit.Cureus. 2023;15(2):e35322. doi:10.7759/cureus.35322Kaiser P, Kellermann F, Arora R, Henninger B, Rudisch A.Diagnosing extensor carpi ulnaris tendon dislocation with dynamic rotation MRI of the wrist.Clin Imaging. 2018;51:323-326. doi:10.1016/j.clinimag.2018.06.015
13 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Erpala F, Ozturk T.“Snapping” of the extensor carpi ulnaris tendon in asymptomatic population.BMC Musculoskelet Disord. 2021;22(1):387. doi:10.1186/s12891-021-04271-zPang EQ, Yao J.Ulnar-sided wrist pain in the athlete (TFCC/DRUJ/ECU).Curr Rev Musculoskelet Med. 2017;10(1):53-61. doi:10.1007%2Fs12178-017-9384-9Medline Plus.Tendon vs. ligament.American Society for Surgery of the Hand.Anatomy 101: wrist tendons.American Society for Surgery of the Hand.Tendons.Adams J, Habbu R.Tendinopathies of the hand and wrist.J Am Acad Orthop Surg. 2015;23(12):741-750. doi:10.5435/jaaos-d-14-00216NYU Langone Health.Diagnosing bursitis & tendonitis in adults.Docking SI, Ooi CC, Connell D.Tendinopathy: is imaging telling us the entire story?J Orthop Sports Phys Ther. 2015;45(11):842-852. doi:10.2519/jospt.2015.5880American Academy of Family Physicians.Diagnostic and therapeutic injection of the wrist and hand regions.Erpala F, Ozturk T.“Snapping” of the extensor carpi ulnaris tendon in asymptomatic population.BMC Musculoskelet Disord. 2021;22(1):387. doi: 10.1186/s12891-021-04271-zRios-Russo JL, Lozada-Bado LS, de Mel S, Frontera W, Micheo W.Ulnar-sided wrist pain in the athlete: sport-specific demands, clinical presentation, and management options.Curr Sports Med Rep. 2021;20(6):312-318. doi:10.1249/JSR.0000000000000853Vomer RP 2nd, Lewno AJ, Udoh I, Albano-Aluquin S, Pujalte GGA.Evaluation of the hand and wrist via telephone and video visit.Cureus. 2023;15(2):e35322. doi:10.7759/cureus.35322Kaiser P, Kellermann F, Arora R, Henninger B, Rudisch A.Diagnosing extensor carpi ulnaris tendon dislocation with dynamic rotation MRI of the wrist.Clin Imaging. 2018;51:323-326. doi:10.1016/j.clinimag.2018.06.015
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Erpala F, Ozturk T.“Snapping” of the extensor carpi ulnaris tendon in asymptomatic population.BMC Musculoskelet Disord. 2021;22(1):387. doi:10.1186/s12891-021-04271-zPang EQ, Yao J.Ulnar-sided wrist pain in the athlete (TFCC/DRUJ/ECU).Curr Rev Musculoskelet Med. 2017;10(1):53-61. doi:10.1007%2Fs12178-017-9384-9Medline Plus.Tendon vs. ligament.American Society for Surgery of the Hand.Anatomy 101: wrist tendons.American Society for Surgery of the Hand.Tendons.Adams J, Habbu R.Tendinopathies of the hand and wrist.J Am Acad Orthop Surg. 2015;23(12):741-750. doi:10.5435/jaaos-d-14-00216NYU Langone Health.Diagnosing bursitis & tendonitis in adults.Docking SI, Ooi CC, Connell D.Tendinopathy: is imaging telling us the entire story?J Orthop Sports Phys Ther. 2015;45(11):842-852. doi:10.2519/jospt.2015.5880American Academy of Family Physicians.Diagnostic and therapeutic injection of the wrist and hand regions.Erpala F, Ozturk T.“Snapping” of the extensor carpi ulnaris tendon in asymptomatic population.BMC Musculoskelet Disord. 2021;22(1):387. doi: 10.1186/s12891-021-04271-zRios-Russo JL, Lozada-Bado LS, de Mel S, Frontera W, Micheo W.Ulnar-sided wrist pain in the athlete: sport-specific demands, clinical presentation, and management options.Curr Sports Med Rep. 2021;20(6):312-318. doi:10.1249/JSR.0000000000000853Vomer RP 2nd, Lewno AJ, Udoh I, Albano-Aluquin S, Pujalte GGA.Evaluation of the hand and wrist via telephone and video visit.Cureus. 2023;15(2):e35322. doi:10.7759/cureus.35322Kaiser P, Kellermann F, Arora R, Henninger B, Rudisch A.Diagnosing extensor carpi ulnaris tendon dislocation with dynamic rotation MRI of the wrist.Clin Imaging. 2018;51:323-326. doi:10.1016/j.clinimag.2018.06.015
Erpala F, Ozturk T.“Snapping” of the extensor carpi ulnaris tendon in asymptomatic population.BMC Musculoskelet Disord. 2021;22(1):387. doi:10.1186/s12891-021-04271-z
Pang EQ, Yao J.Ulnar-sided wrist pain in the athlete (TFCC/DRUJ/ECU).Curr Rev Musculoskelet Med. 2017;10(1):53-61. doi:10.1007%2Fs12178-017-9384-9
Medline Plus.Tendon vs. ligament.
American Society for Surgery of the Hand.Anatomy 101: wrist tendons.
American Society for Surgery of the Hand.Tendons.
Adams J, Habbu R.Tendinopathies of the hand and wrist.J Am Acad Orthop Surg. 2015;23(12):741-750. doi:10.5435/jaaos-d-14-00216
NYU Langone Health.Diagnosing bursitis & tendonitis in adults.
Docking SI, Ooi CC, Connell D.Tendinopathy: is imaging telling us the entire story?J Orthop Sports Phys Ther. 2015;45(11):842-852. doi:10.2519/jospt.2015.5880
American Academy of Family Physicians.Diagnostic and therapeutic injection of the wrist and hand regions.
Erpala F, Ozturk T.“Snapping” of the extensor carpi ulnaris tendon in asymptomatic population.BMC Musculoskelet Disord. 2021;22(1):387. doi: 10.1186/s12891-021-04271-z
Rios-Russo JL, Lozada-Bado LS, de Mel S, Frontera W, Micheo W.Ulnar-sided wrist pain in the athlete: sport-specific demands, clinical presentation, and management options.Curr Sports Med Rep. 2021;20(6):312-318. doi:10.1249/JSR.0000000000000853
Vomer RP 2nd, Lewno AJ, Udoh I, Albano-Aluquin S, Pujalte GGA.Evaluation of the hand and wrist via telephone and video visit.Cureus. 2023;15(2):e35322. doi:10.7759/cureus.35322
Kaiser P, Kellermann F, Arora R, Henninger B, Rudisch A.Diagnosing extensor carpi ulnaris tendon dislocation with dynamic rotation MRI of the wrist.Clin Imaging. 2018;51:323-326. doi:10.1016/j.clinimag.2018.06.015
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