Extensor carpi ulnaris (ECU) tendinopathy is irritation or overload of the ECU tendon, which runs along the little-finger side of the back of the wrist, causing pain with gripping, twisting and wrist movement.
The extensor carpi ulnaris (ECU) is a forearm muscle that helps bend the wrist backwards and towards the little finger. Its tendon passes through a groove at the end of the ulna bone and is held in place by a sheath. When the tendon is loaded more than it can cope with, it can become painful and less able to handle strain. This is called tendinopathy. If the lining of the sheath is also inflamed, doctors may call it tenosynovitis.
ECU tendinopathy is a common cause of pain on the ulnar (little-finger) side of the wrist. It often affects people who play racquet sports such as tennis, badminton or pickleball, and golfers. A related problem, ECU subluxation, happens when the tendon slips out of its groove, often with a painful snap when turning the palm up. The two can occur together, so the doctor will check for both.
The doctor asks how the pain started and which activities make it worse, then examines the wrist. Specific tests check the ECU tendon and whether it stays in its groove when you rotate your forearm.
Where it helps, an ultrasound scan can show thickening or fluid around the tendon. Scanning while you move the wrist may show whether the tendon is slipping out of place.
Other causes of ulnar-sided wrist pain, such as a TFCC (cartilage) injury, joint problems or a fracture, are considered. If needed, an X-ray or MRI can be arranged by referral.
Your plan depends on what the assessment finds. These are the options we most often discuss.
Reducing the activities that provoke pain, such as certain strokes or heavy gripping, gives the tendon a chance to settle. Most people can stay active with some changes.
A wrist splint worn for a period may help calm symptoms by limiting painful movement, especially if the tendon is unstable.
A graded programme to strengthen the wrist and forearm is often the main part of recovery, with a gradual return to sport.
Learn moreTaping or a wrist support may help during a return to racquet sports or golf.
Learn moreWhere assessed as suitable, an image-guided injection into the tendon sheath may ease pain that has not settled with other measures. It is used carefully and not repeated often.
Learn moreChecking grip size, racquet or club set-up, and technique may reduce strain on the tendon. Pain relief medicines may help in the short term.
Many people improve over 6 to 12 weeks with load management and a structured exercise programme, although the time frame varies. Longer-standing symptoms may take a few months to settle. If the tendon keeps slipping out of its groove despite splinting and rehabilitation, or pain persists, the doctor may refer you to a hand or orthopaedic surgeon to discuss further options, which can include surgery to stabilise the tendon.
No. Tennis elbow affects tendons on the outer side of the elbow. ECU tendinopathy affects a tendon at the wrist, on the little-finger side. Both can be linked to racquet sports, and some people have both.
ECU subluxation is when the tendon slips out of its groove at the wrist, often with a painful snap or click when the palm is turned up. It can happen after a sudden injury or develop gradually. It is treated differently from simple tendinopathy, so it is worth having it checked.
Often you can continue with changes, such as playing less often, avoiding the strokes that hurt, or using taping. Playing through sharp or worsening pain may slow recovery. Your doctor can help plan a gradual return.
Most people are managed without surgery. Surgery may be considered if the tendon remains unstable or symptoms persist despite a good trial of treatment. In that case, the clinic will refer you to a hand or orthopaedic surgeon.
No. Inflexion Clinic is a private GP clinic, so you can book directly. Book online or call the clinic on +65 8997 0659.
Our clinicians will take a proper history, examine you, and give you a clear plan on the day.