Extensor Carpi Ulnaris Tendinopathy

Typical Symptoms

Tendinopathy of the Extensor Carpi Ulnaris (ECU) tendon usually causes pain and limited movement along the medial (inner) aspect of the wrist i.e. on the pinky side.

Pain is usually brought on by extension or twisting (such as opening door handles) movements of the hand or wrist and is localized to a specific area. Sometimes there can be swelling and redness depending on how irritated the area is.

What causes it?

This problem often arises after overloading the ECU tendon, either from doing nothing at all or from a non-graduated approach in active individuals. It can be due to sports, gym or another activity such as DIY.

If symptoms become more chronic in nature, then there can be tearing or degenerative changes in the tendon itself.

How can I help myself?

For most cases, the symptoms will settle down with a wrist splint, PRICE measures and topical anti-inflammatory medication. Sometimes, additional analgesic medications might be needed to help with pain symptoms.

You could also consider acupuncture or more manual therapy for tissue tightness, but must be careful that this does not worsen things. If it is due to your sporting activities, working with a coach can help improve your technique etc.

When to seek help?

If the wrist pain continues to limit your activities or if it is not improving despite the measures suggested, it is probably a good idea to be seen before it becomes a chronic issue.

What are the treatment options?

Following initial assessment where your clinician will take a thorough history and examination, they might organise an ultrasound of your wrist to assess the ECU tendon and identify whether it is a tendinopathy or if a tear is noted as well. Should a tear be noted, a follow-up MRI might be useful to confirm this.

Treatment often relies on physiotherapy and hand therapy with splinting and exercises. However, in tendinopathy cases, a cortisone injection can help settle pain symptoms and if a tear is noted, a PRP injection can be helpful. This should be discussed with your doctor prior to being undertaken.

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