Pathologies of the Extensor Carpi Ulnaris (ECU) Tendon and its Investments in the Athlete

Thomas J. Graham, MDa,b,*

KEYWORDS
 Extensor carpi ulnaris (ECU)  Subluxation  Extensor retinaculum  Linea jugata  Ulnar sulcus

KEY POINTS
 Although it is attractive to intellectually separate the distinct anatomic structures about the sixth compartment, it must be embraced that comprehensive understanding of extensor carpi ulnaris (ECU)-related pathologies requires recognition that this is really a system.  It is necessary to maintain a high level of suspicion for ECU problems, among other ulnar wrist pathologies, as well as acute diagnostic skill and a portfolio of therapeutic alternatives for its treatment.  Dysfunction and even loss of the ECU does not necessarily translate into a career-ending event, but counseling and flexibility in approaching the craft of hitting are required to regain playing status.

INTRODUCTION
How many times have you read an article in which the author states that the pathology reported is rare or uncommon, only to reflect on your personal experience and deduce that you either have the worlds largest experience or that you have been misdiagnosing the entity you thought was the disorder in question?1 Such is the case with ECU tendon problems for those who care for an athletic population, especially elite athletes. Many authors start out describing how uncommon injuries and disorders about the sixth dorsal compartment are, whereas those who have dedicated significant time to the study and care of stick-and-ball athletes have a full appreciation for the unique anatomy, unusual forces, and proclivity for injury exhibited by the structures.2,3 There are few, if any, athletic pursuits that cannot be considered hand intensive, and fewer still that do not involve some violent, powerful action of

the wrists when wielding some form of bat, club, or stick through a hitting zone. All these actions place stress on the musculotendinous unit of the ECU and its investments. It is imperative that hand surgeons involved in the care of baseball, hockey, tennis, and golf athletes (some of the most frequent sports in which ECU pathologies are abundant) appreciate the anatomic and mechanical elements of ECU pathology. It is necessary to maintain a high level of suspicion for ECU problems, among other ulnar wrist pathologies, as well as acute diagnostic skill and a portfolio of therapeutic alternatives for their treatment.

PERTINENT ANATOMY AND MECHANICS OF THE ECU COMPLEX

I have challenged prior investigators regarding their depiction of ECU tendon issues as rare; however, I agree with the unanimous appreciation

a Cleveland Clinic Innovations, 9500 Euclid Avenue, GCIC-10, Cleveland, OH 44195, USA; b Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Avenue, GCIC-10, Cleveland, OH 44195, USA * Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Avenue, GCIC-10, Cleveland, OH 44195. E-mail address: grahamt@ccf.org

Hand Clin 28 (2012) 345356 doi:10.1016/j.hcl.2012.05.049 0749-0712/12/$ see front matter 2012 Elsevier Inc. All rights reserved.

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