J Korean Orthop Assoc.  2018 Jun;53(3):256-263. 10.4055/jkoa.2018.53.3.256.

Operative Treatment for Extensor Carpi Ulnaris Tendon Dislocation

• Oh BS
• Choi YR
• Ko IH
• Oh WT
• Eom NG
• Kang HJ

• KMID: 2429174
• DOI: http://doi.org/10.4055/jkoa.2018.53.3.256

Abstract

PURPOSE
Extensor carpi ulnaris (ECU) subluxation has a low incidence rate, to date, there has only been a few studies evaluating the operative treatment for type of injury. The purpose of this study was to retrospectively analyze 11 patients with ECU subluxation who underwent operative treatment.
MATERIALS AND METHODS
Between March 2005 and February 2015, 11 patients received operative treatment. Magnetic resonance imaging and dynamic ultrasound were used to make the diagnosis. ECU subluxation patterns were classified by the Inoue's classification system. There were two cases of type A, one case of type B, five cases of type C, and three cases unfit for Inoue's classification. We also found two cases of radial subluxation and one case of ulnar locked subluxation. In type A and B cases, ECU tendons were relocated then sheaths repair was performed, and the extensor retinaculum reconstruction was performed. In type C cases, the fibro-osseous sheaths were fixed. In the three unclassified cases, extensor retinaculum reconstruction was performed. In all cases, fibro-osseous sheaths were fixed using the anchor suture technique. We compared the clinical results based on the following: motion range of the wrist joint; grip strength; visual analogue scale (VAS) score; quick disabilities of the arm, shoulder and hand (Q-DASH) score; and Mayo wrist score.
RESULTS
The median age of patients at the time of the operation was 32 years, and the average follow-up period was 11.2 months. There were five cases of triangular fibrocartilage complex tear, two cases of distal radioulnar joint instability, three cases of ECU split tear as accompanying injury. There were significant differences in the clinical results. The average motion range of the wrist increased compared with the preoperative value (84.7% to 92.4% compared to contralateral normal side). The postoperative VAS score, Q-DASH score and Mayo wrist score showed better results compared with the respective preoperative values (6.0 to 1.1, 40.9 to 12.4, 75.9 to 86.4).
CONCLUSION
ECU subluxation is a rare occurrence. Dynamic ultrasound is useful in diagnosing ECU tendon subluxation. Satisfactory results can be obtained with the use of a proper technique, which depends on the type of subluxation.

Keyword

extensor carpi ulnaris; dislocation; operative treatment

MeSH Terms

Arm
Classification
Diagnosis
Dislocations*
Follow-Up Studies
Hand
Hand Strength
Humans
Incidence
Joint Instability
Magnetic Resonance Imaging
Retrospective Studies
Shoulder
Suture Techniques
Tears
Tendons*
Triangular Fibrocartilage
Ultrasonography
Wrist
Wrist Joint

Figure

• 

  Figure 1 Classic Inoue classification and unclassified cases: the ulnar locked case and radial locked case.

• 

  Figure 2 Fixation of the fibro-osseous sheath with anchor suture. The anchor suture was inserted into the ulnar border of ulnar groove.

• 

  Figure 3 A 45-year-old male patient with extensor carpi ulnaris (ECU) dislocation. (A) Dynamic ultrasound showed ECU subluxation and split tear (white arrow). On magnetic resonance imaging, (B) axial image showed ECU subluxation and split tear (white arrow), and (C) coronal image shows triangular fibrocartilage complex 1C tear (white arrow). (D) The ruptured fibro-osseous sheath was fixed with anchor suture.

• 

  Figure 4 A 22-year-old male patient with extensor carpi ulnaris (ECU) dislocation. (A) Magnetic resonance imaging showed ulnar side locked ECU dislocation (white arrow) and ulnar head dorsal subluxation caused by triangular fibrocartilage complex tear. (B, C) After ECU relocation, fibro-osseous sheath was fixed with anchor suture.

Reference

1. Burkhart SS, Wood BM, Linscheid LR. Posttraumatic recurrent subluxation of the extensor carpi ulnaris tendon. J Hand Surg Am. 1982; 7:1–3.

2. Rayan GM. Recurrent dislocation of the extensor carpi ulnaris in athletes. Am J Sports Med. 1983; 11:183–184.

3. MacLennan AJ, Nemechek MN, Waitayawinyu T, Trumble TE. Diagnosis and anatomic reconstruction of extensor carpi ulnaris subluxation. J Hand Surg Am. 2008; 33:59–64.

4. Lee KS, Ablove RH, Singh S, De Smet AA, Haaland B, Fine JP. Ultrasound imaging of normal displacement of the extensor carpi ulnaris tendon within the ulnar groove in 12 forearm-wrist positions. AJR Am J Roentgenol. 2009; 193:651–655.

5. Pratt RK, Hoy GA, Bass Franzcr C. Extensor carpi ulnaris subluxation or dislocation? Ultrasound measurement of tendon excursion and normal values. Hand Surg. 2004; 9:137–143.

6. Inoue G, Tamura Y. Surgical treatment for recurrent dislocation of the extensor carpi ulnaris tendon. J Hand Surg Br. 2001; 26:556–559.

7. Taleisnik J, Gelberman RH, Miller BW, Szabo RM. The extensor retinaculum of the wrist. J Hand Surg Am. 1984; 9:495–501.

8. Taleisnik J. Pain on the ulnar side of the wrist. Hand Clin. 1987; 3:51–68.

9. Iida A, Omokawa S, Moritomo H, et al. Biomechanical study of the extensor carpi ulnaris as a dynamic wrist stabilizer. J Hand Surg Am. 2012; 37:2456–2461.

10. Allende C, Le Viet D. Extensor carpi ulnaris problems at the wrist: classification, surgical treatment and results. J Hand Surg Br. 2005; 30:265–272.

11. Spinner M, Kaplan BE. Extensor carpi ulnaris. Its relationship to the stability of the distal radio-ulnar joint. Clin Orthop Relat Res. 1970; 68:124–149.

12. Oka Y, Handa A. Recurrent dislocation of the ECU tendon in a golf player: release of the extensor retinaculum and partial resection of the ulno-dorsal ridge of the ulnar head. Hand Surg. 2001; 6:227–230.

13. Crimmins CA, Jones NF. Stenosing tenosynovitis of the extensor carpi ulnaris. Ann Plast Surg. 1995; 35:105–107.

14. Osterman AL, Moskow L, Low DW. Soft-tissue injuries of the hand and wrist in racquet sports. Clin Sports Med. 1988; 7:329–348.

15. Wang C, Gill TJ 4th, Zarins B, Herndon JH. Extensor carpi ulnaris tendon rupture in an ice hockey player: a case report. Am J Sports Med. 2003; 31:459–461.

16. Iorio ML, Bayomy AF, Huang JI. Morphology of the extensor carpi ulnaris groove and tendon. J Hand Surg Am. 2014; 39:2412–2416.