Overview
ECU tendinitis is an inflammation of the extensor carpi ulnaris tendon, found on the pinky side of the hand. Symptoms include wrist pain and loss of grip strength. ECU tendinitis symptoms are made worse by combined wrist motion towards the pinky side and moving the palm up and down. Wrist motion towards the pinky side occurs slightly just before impact, but it occurs at a faster speed while the wrist is under high degrees of stress. Golfers with a tendency toward 'casting' are at risk of developing this inflammation.
Pain in the wrist area may also be a sign of a more serious injury, including a rupture of the tendon sheath that holds the ECU tendon in place. The pain may be more on the pinky side of the forearm than in the wrist. When there is a tear, the tendon is no longer supported and can roll in and out of the tendon groove, a problem known as subluxation.
ECU subluxations are rare. When it happens, the golfer usually complains of a painful snap as the tendon rolls out with the palm down motion in the downswing. If the patient's symptoms do not improve with conservative treatment, surgery may be necessary to repair the ECU and surrounding tissues.
Treatment
Treatment depends on the extent of the injury. Conservative treatment consists of rest, immobilizing the wrist with a splint, applying ice and taking non-steroidal anti-inflammatory medication such as ibuprofen or naproxen.
Wrist Splint
Golfers with this injury should avoid forceful, repetitive, or sustained thumb motion away from the hand or wrist. Motion towards the pinky side may aggravate this condition, and activities that may cause pain include gripping, pinching and twisting. Combining thumb and wrist motion should also be avoided.
Tendinitis of the wrist and hand commonly occurs in the lead hand during the golf swing and can be caused by excessive cocking and bending of the left wrist on the backswing or rapid deviation of the wrist at impact. A "strong grip" position, in which the hands are rotated clockwise on the club handle, may also increase the likelihood of wrist tendinitis.
Most golf-induced wrist injuries due to overuse are successfully treated non-operatively, but the golfer may have to give up the game for an extended period of time. If initial treatments fail, cortisone injections may provide relief.
If the problem results from a sudden injury, the wrist should be immobilized for four to six weeks. After that, depending on the injury, golfers can slowly return to play.
Wrist Brace
If a golfer has persistent symptoms, wearing a wrist brace (see photo) may help, but reconstruction of the tendon sheath tunnel is usually necessary to provide permanent relief.