From the Guidelines
Treatment of extensor carpi ulnaris tenosynovitis should begin with conservative measures, including relative rest, reduced activity, and eccentric strengthening exercises, as these methods have been shown to promote healing and pain relief 1.
Key Recommendations
- Relative rest and reduced activity to prevent further damage and promote healing and pain relief 1
- Cryotherapy, such as ice application, for acute relief of tendinopathy pain 1
- Eccentric strengthening exercises to reverse degenerative changes and promote healing 1
- Nonsteroidal anti-inflammatory drugs (NSAIDs) for short-term pain relief, but not for long-term outcomes 1
Treatment Approach
The treatment approach for extensor carpi ulnaris tenosynovitis typically involves a combination of conservative measures, including:
- Immobilization with a wrist splint or brace for 2-6 weeks
- NSAIDs, such as ibuprofen or naproxen, for pain and inflammation
- Ice application for 15-20 minutes several times daily
- Physical therapy focusing on gentle stretching and strengthening exercises
- Corticosteroid injections, such as methylprednisolone, around the tendon sheath for persistent cases
Surgical Options
If conservative treatment fails after 3-6 months, surgical options, including tenosynovectomy, tendon repair, or subsheath reconstruction, may be necessary 1. Surgery is particularly indicated when there is tendon instability or subluxation. Post-surgical rehabilitation is crucial and typically involves immobilization for 2-4 weeks followed by gradual return to activities over 2-3 months.
Evidence-Based Practice
The evidence-based practice for treating extensor carpi ulnaris tenosynovitis is based on the American Family Physician guidelines, which recommend a conservative approach, including relative rest, reduced activity, and eccentric strengthening exercises, as the first line of treatment 1.
From the Research
Treatment Options for Extensor Carpi Ulnaris Tenosynovitis
- Conservative treatment consisting of splinting and steroid injection can be effective in treating extensor carpi ulnaris tenosynovitis, as seen in a study where all patients had ulnar-sided wrist pain and underwent this treatment, with 8 out of 15 patients achieving good or excellent results 2.
- Rehabilitation via occupational or physical therapy, including therapeutic exercise, splinting, activity modification, manual therapy, and modalities, can also be used to treat extensor carpi ulnaris tendinopathy, allowing patients to return to their desired activities 3.
- In cases where conservative treatment fails, surgical release may be required, with some patients requiring reconstruction of the floor of the compartment due to partially ruptured tendons from exposed bone 2.
- A novel technique using ultrasound-guided retinaculum release of the sixth dorsal compartment has also been successfully used to treat chronic extensor carpi ulnaris stenosing tenosynovitis 4.
- Wrist arthroscopy and open surgical repair can also be effective in treating subacute/chronic ECU tendinopathy, with significant improvements in functional outcomes, including range of motion, grip strength, and pain scores 5.
Considerations for Treatment
- The possibility of triangular fibrocartilage complex (TFCC) combined injury should always be considered when treating patients with ECU tendinopathy, and wrist arthroscopy can be used for more accurate diagnosis of intra-articular pathology 5.
- A combination of conservative measures and rehabilitation can be used to treat ECU tendinopathy, and surgical options such as revision scenarios can be effective in cases where symptoms persist or worsen after initial treatment 6.