Journal List > J Korean Orthop Assoc > v.52(2) > 1013505

Lee and Oh: Tendon Problems of the Ulnar Wrist

Abstract

It is challenging for orthopedic surgeons to diagnose pain at the ulnar aspect of the wrist due to the small and complex anatomical structures involved. Ulnar-sided wrist pain can also result from tendon problems, including extensor carpi ulnaris tendon and flexor carpi ulnaris tendon. Disorders of the extensor carpi ulnaris tendon include subluxation, dislocation, stenosing tenosynovitis, and tendinopathy. Unlike the extensor carpi ulnaris tendon which is prone to subluxation, dislocation and stenosing tenosynovitis from passing through as sheath, a flexor carpi ulnaris tendon is unsheathed, and calcific tendinitis and crystal deposition disease can occur at the distal tendinous portion of the flexor carpi ulnaris tendon.

Figures and Tables

Figure 1

Axial fast spin echo proton density magnetic resonance imaging scan of the wrist. Extensor carpi ulnaris tendinitis is presented as inflammation of the synovial lining of the extensor carpi ulnaris and is frequently associated with intrinsic tendon degeneration.

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Figure 2

Axial dynamic ultrasound images. In wrist supination, extensor carpi ulnaris (ECU) tendon leaves its sheath or its osseous groove. Left arrow, normal relationship between ECU and ulnar styloid process; right arrow, ECU dislocated on ulnar styloid process; u, ulnar styloid process.

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Figure 3

Thirty-degree supinated lateral radiograph demonstrating pisotriquetral arthritis.

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Figure 4

Calcification of the flexor carpi ulnaris just proximal to the insertion on the pisiform is shown in the carpal tunnel view.

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Figure 5

Longitudinal ultrasound image of the flexor carpi ulnaris (FCU). Irregular calcifications around FCU tendon insertion site of the pisiform is shown.

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Figure 6

If symptoms persist despite aggressive nonsurgical management, operative treatment may be indicated. (A) The flexor carpi ulnaris is usually approached through a zigzag incision directly over the flexor carpi ulnaris, extending distally over the pisiform. (B) The flexor carpi ulnaris is identified and retracted radially. (C) The crystalline material and any degenerative tendon and inflammatory tissue are then debrided. (D) Resected crystallin material and hypertrophied pisiform are shown (right lower).

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Notes

CONFLICTS OF INTEREST The authors have nothing to disclose.

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