Extensor Carpi Ulnaris Tendinitis

with Rehab

ExitCare ImageTendonitis involves inflammation of a tendon, which is a soft tissue that connects muscle to bone. The Extensor Carpi Ulnaris (ECU) tendon is vulnerable to tendonitis. The ECU is responsible for straightening and rotating (abducting) the wrist. The ECU is important for gripping and pulling. ECU tendonitis may include inflammation of the ECU tendon lining (sheath). The tendon sheath usually secretes a fluid that allows the tendon to function smoothly, but when it becomes inflamed, function is impaired. This condition may also include a tear in the ECU tendon or muscle (strain). The strain may be classified as a grade 1 or 2 strain. Grade 1 strains cause pain, but the tendon is not lengthened. Grade 2 strains include a lengthened ligament, due to being stretched or partially ruptured. With grade 2 strains there is still function, although the function may be reduced.

SYMPTOMS

  • Pain, tenderness, swelling, warmth, or redness on the little finger side of the wrist.

  • Pain that worsens when straightening the wrist or bending it toward the little finger.

  • Pain with gripping.

  • Limited motion of the wrist.

  • Crackling sound (crepitation) when the tendon or wrist is moved or touched.

CAUSES

ECU tendonitis is caused by injury to the ECU tendon. It is usually due to chronic or repetitive injuries, but may be due to sharp (acute) injury. Common causes of injury include:

  • Strain from unusual use, overuse, or increase in activity, or change in activity of the wrist, hand, or forearm.

  • Direct hit (trauma) to the muscles and tendon on the side of the wrist.

  • Repetitive motions of the hand and wrist, due to friction of the tendon within the tendon lining.

RISK INCREASES WITH:

  • Sports that involve repetitive hand and wrist motions (i.e. golfing, bowling).

  • Sports that require gripping (i.e. tennis, golf, weightlifting).

  • Heavy labor.

  • Poor wrist and forearm strength and flexibility.

  • Failure to warm-up properly before activity.

PREVENTION

  • Warm up and stretch properly before activity.

  • Allow the body to recover between activities.

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness.

  • Learn and use proper exercise technique.

PROGNOSIS

If treated properly, ECU tendonitis is usually curable within 6 weeks.

RELATED COMPLICATIONS

  • Longer healing time, if not properly treated or if not given adequate time to heal.

  • Chronically inflamed tendon, causing persistent pain with activity. This may progress to constant pain, restriction of motion, and potentially tearing of the tendon.

  • Recurring symptoms, especially if activity is resumed too soon.

  • Risks of surgery: infection, bleeding, injury to nerves, continued pain, incomplete release of the tendon lining, recurring symptoms, cutting of the tendon, and weakness of the wrist and grip.

TREATMENT

Treatment initially involves the use of ice and medicine, to help reduce pain and inflammation. Performing stretching and strengthening exercises regularly is important for a quick recovery. These exercises may be completed at home or with a therapist. Your caregiver may recommend the use of a brace or splint to reduce motions that aggravate symptoms. Corticosteroid injections may be recommended. If non-surgical treatment is unsuccessful, then surgery may be needed.

MEDICATION

  • If pain medicine is needed, nonsteroidal anti-inflammatory medicines (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often recommended.

  • Do not take pain medicine for 7 days before surgery.

  • Prescription pain relievers may be given if your caregiver thinks they are needed. Use only as directed and only as much as you need.

  • Corticosteroid injections may be given to reduce inflammation. However, these injections should be reserved for serious cases, as they may only be given a certain number of times.

COLD THERAPY

Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours, and immediately after activity that aggravates your symptoms. Use ice packs or an ice massage.

SEEK MEDICAL CARE IF:

  • Symptoms get worse or do not improve in 2 weeks, despite treatment.

  • You experience pain, numbness, or coldness in the hand.

  • Blue, gray, or dark color appears in the fingernails.

  • Any of the following occur after surgery: increased pain, swelling, redness, drainage of fluids, bleeding in the surgical area, or signs of infection.

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Extensor Carpi Ulnaris Tendinitis

These are some of the initial exercises you may start your recovery program with, until you see your caregiver again or until your symptoms are resolved. Remember:

  • Flexible tissue is more tolerant of the stresses placed on it during activity.

  • Each stretch should be held for 20 to 30 seconds.

  • A gentle stretching sensation should be felt.

ExitCare Image RANGE OF MOTION - Wrist Flexion

  • Hold your right / left wrist with the fingers pointing down toward the floor.

  • Pull down on the wrist until you feel a stretch.

  • Hold this position for __________ seconds. Repeat exercise __________ times, __________ times per day.

  • This exercise should be done with the elbow:

_____ Bent to 90 degrees.

_____ Straight.

ExitCare Image RANGE OF MOTION - Wrist Flexion

  • Place the back of your right / left hand flat on the top of a table. Your shoulder should be turned in and your fingers facing away from your body.

  • Press down, bending your wrist and straightening your elbow until your feel a stretch.

  • Hold this position for __________ seconds.

  • Repeat exercise __________ times, __________ times per day.

STRENGTHENING EXERCISES - Extensor Carpi Ulnaris Tendinitis

These are some of the initial exercises you may start your recovery program with, until you see your caregiver again or until your symptoms are resolved. Remember:

  • Strong muscles with good endurance tolerate stress better.

  • Do the exercises as initially prescribed by your caregiver. Progress slowly with each exercise, gradually increasing the number of repetitions and weight used, only as guided.

ExitCare Image RANGE OF MOTION - Wrist Extensors

  • Sit or stand with your forearm supported.

  • Using a __________ weight or a piece of rubber band or tubing, bend your wrist slowly upward toward you.

  • Hold this position for __________ seconds and then slowly lower the wrist back to the starting position.

  • Repeat exercise __________ times, __________ times per day.

ExitCare Image RANGE OF MOTION - Wrist, Ulnar Deviation

  • Stand with a hammer in your hand, or sit while holding onto a rubber band or tubing with both hands, and with your arm supported on a table.

  • Raise your hand with the hammer upward behind you, or pull down on the rubber tubing.

  • Hold this position for __________ seconds and then slowly lower the wrist back to the starting position.

  • Repeat exercise __________ times, __________ times per day.

ExitCare Image STRENGTH - Grip

  • Hold a wad of putty, soft modeling clay, a large sponge, a soft rubber ball or a soft tennis ball in your hand.

  • Squeeze as hard as you can.

  • Hold this position for __________ seconds.

  • Repeat exercise __________ times, __________ times per day.