Tendinopathies of the Extensor Carpi Ulnaris

To improve its mechanical advantage, the extensor carpi ulnaris (ECU) muscle uses, as if it was a pulley, the 6(th) extensor compartment, a dorsal fibro-osseous tunnel formed by the ulnar sulcus and the ECU tendon sub-sheath. Rupture or insufficiency of that sheath may allow anteromedial ECU tendon subluxation and subsequent destabilization of the distal radioulnar and ulnocarpal joints. Sometimes, it is not sheath problem, but excessive friction between the sheath and the tendon what causes a painful degeneration of the tendon (tendinosis) with or without tendon entrapment. The term "ECU tendinopathy" has been chosen to designate all painful ECU anomalies resulting from a dysfunctional 6(th) extensor compartment. ECU tendinopathies are frequent among sportsmen using bats, sticks or clubs. There are 2 major types of tendinopathy: 1) constrained tendinopathies, where there is entrapment of a thickened overused tendon, and 2) unconstrained tendinopathies, where a ruptured ECU sub-sheath allows the ECU to sublux in a volar direction, a position precluding all its stabilizing potential. In the first type, the goal of the treatment is to avoid further degeneration and subsequent rupture of the diseased tendon; in the second, to re-establish the normal connections between the ulna and the ECU tendon. This article reviews the management of the most frequent ECU tendinopathies.