Korean J Sports Med.  2023 Dec;41(4):250-255. 10.5763/kjsm.2023.41.4.250.

Novel Therapeutic Approach for Extensor Digiti Minimi Tendon Traction in Chronic Ulnar-Sided Wrist Pain Diagnosed as Triangular Fibrocartilage Complex Injury: A Case Report

• Yang CJ
• Seong JW

• KMID: 2549000
• DOI: http://doi.org/10.5763/kjsm.2023.41.4.250

Abstract

Ulnar-sided wrist pain is common in sports medicine and orthopedics, typically diagnosed as a triangular fibrocartilage complex (TFCC) injury. We present a case study involving a 22-year-old male who has been experiencing chronic left wrist pain for the past 9 months. He was diagnosed with a TFCC injury and received conservative treatment. Surgery was recommended if the pain persisted after 9 months. He exhibited tenderness in the dorsal radioulnar joint region and the proximal one-third portion of the extensor digiti minimi (EDM) muscle. At a tendon traction point (TTP) over the EDM muscle, 4 mL of isotonic saline was injected at presentation, 1 and 3 weeks later. The pain significantly improved, and he did not experience any adverse effects or worsening of his symptoms during the 13-month follow-up. The injection therapy at the TTP of the EDM can be considered in chronic unhealed ulnar-sided wrist pain, including TFCC injury, to release the tightly contracted EDM muscle.

Keyword

Ulnar-sided wrist pain; Triangular fibrocartilage complex; Extensor digiti minimi; Tendon traction point

Figure

• 

  Fig. 1 Magnetic resonance imaging revealed a partial tear of the triangular fibrocartilage complex proximal lamina (arrow).

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  Fig. 2 Ultrasound-guided injection into the proximal one-third portion of the extensor digiti minimi (EDM) muscle, which was most tender. (A) Ultrasonography verified the needle’s placement within the EDM muscle (arrow, 23-gauge needle). (B) Color Doppler ultrasonography confirmed the flow of the injected isotonic saline within the EDM muscle. ECU, extensor carpi ulnaris; EDC, extensor digitorum communis.

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  Fig. 3 One week following the initial injection, Disabilities of the Arm, Shoulder and Hand (DASH) and visual analog scale (VAS) scores showed improvements of 14.1 and 3 points, respectively. These improvements were further enhanced to 20.8 and 5 points, respectively, at the 13-month follow-up after the first injection. Both results exceeded their respective minimal clinically important differences and remained consistent 13 months after the first injection. The VAS scale ranges from 0 to 10, with lower scores indicating better outcomes. Outcome measurements were taken before the injection. The asterisks indicate the time of injection.

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