Extensor Carpi Ulnaris Tenodesis

Professional golfer with persistent pain over the small finger side (ulnar-sided) of his wrist preventing him from competing. Conservative management failed and with each swing he experienced pain. At the time of wrist arthroscopy, global instability (volar and dorsal) of his lunotriquetral joint was noted. Given his need for mobility, an extensor carpi ulnaris tenodesis was chosen to stabilize the joint rather than a simpler lunotriquetral fusion. He returned to his profession with resolution of virtually all symptoms.

The left view (PA) reveals subtle irregularity at the lunotriquetral joint. The right view (Lateral) reveals a carpal instability pattern called Volar Intercalated Instability (VISI).

Intra-operative video revealing global instability at the lunotriquetral joint.

extensor carpi ulnaris tendon graft
Operative Techniques in Hand, Wrist, and Elbow Surgery – Ed. Hunt TR, Wolters Kluwer, 2016

An extensor carpi ulnaris (ECU) tendon graft was harvested, incised at the junction with the muscle in the forearm, and split to its insertion on the dorsal base of the small finger metacarpal bone.  The graft was then inserted into the triquetrum, across the unstable lunotriquetral joint, and out the dorsal lunate.  By pulling the graft tightly back to the triquetral insertion site, the joint is secured.  The lunotriquetral joint was then pinned temporarily to allow the graft to heal.

The left image (PA) shows a reduced lunotriquetral joint with the bone tunnel visible through the triquetrum and the lunate. The right image (Lateral) reveals correction of the VISI instability pattern.

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