gms | German Medical Science

Objectives/Interrogation: Extensor carpi ulnaris (ECU) subluxation at the wrist joint can be a disabling condition. We present our experience with this problem.

Methods: From 2012 to 2017, we evaluated 21 patients with a diagnosis of ECU as subluxation, tenosynovitis and longitudinal fissuring. The cohort included 8 women and 13 men (average age 32 years). Timing of presentation: 11 acute trauma and 10 chronic post traumatic (from 6 months to 2 years post trauma). None of the patients had pain or instability of the distal radioulnar joint; 7 patients (33%) play tennis golf or sport activity with bats.

All patients underwent splinting and physiotherapy. Patients who failed conservative treatment were indicated for surgical stabilization of the ECU tendon. Post-operatively patients were placed in a sugar tongue splint day and night for 6 weeks and then a forearm splint at night for an additional 2 months. Return to sports and heavy work was allowed at 6 months.

Results and Conclusions: All patients with an acute trauma had resolution of symptoms with therapy and splinting and returned to work and sports uneventfuly. All patients with a chronic injury ended up requiring surgery. In 8 patients we performed a Graham ulnar retinacular flap with augmentation on the 4/5 septum; in 2 patients we performed a Garcia Elias ulnar retinacular flap, capsular flap and periosteum flap. After the Graham flap 6 patients had a good result with regard to return to work and/or return to sports; 1 patient had continued symptoms that subsequently resolved at the 1 year mark; and the final patient (tennis player) had persistant pain and recurrent tenosynovitis after the surgery but actually after PRP injection she is getting better. In 2 patients operated with Garcia Elias technique we had good results with regard to return to sports and work. No statistically significative differences as result between sport and labour patients. No more ECU subluxation/luxation in all patients operated. No pain (except one patient); complete wrist range of motion in all patients; no complications during and after surgery.

A careful evaluation for ECU subluxation should be performed when dealing with ulnar-sided wrist pain.