ECU Subluxation Treatment (My Experiences)

Are You Dealing with a Snapping Wrist? Read About My ECU Subluxation Treatment

In the summer of 2009, I injured myself while lifting weights. Really, what happened was I was performing power cleans until I heard a “pop” in my wrist. I later found out this “pop” was ECU tendon subluxation.

With ECU tendon subluxation, what happens is that the distal tendon of the extensor carpi ulnaris dislocates out of the tunnel on the ulna bone when performing certain movements, then re-enters the tunnel it was supposed to be held in. Basically, a tendon pops in-and-out of your wrist bone. To illustrate, here’s a video of a subluxation occurring.

 

As you can see in the video, there is a long “bulge” in the person’s wrist. This is the tendon of the extensor carpi ulnaris, and it’s dislocating itself. The problem with this injury isn’t necessarily impairment of the function of this wrist-extending muscle – one can actually function quite well if the sensation of snapping isn’t bothersome. The eventual inflammation of the tendon is what becomes problematic for people. This is because the recurrent snapping causes microtrauma to the tendon that never gets to heal.

Over time, it makes sense that the tendon can become damaged, eventually affecting the function of the extensor carpi ulnaris. Until then, it’s just a weird “snapping” sensation and some pain.

I don’t know about you, but I wasn’t willing to deal with the pain and snapping. It was a constant reminder that my wrists were screwed up. So, I sought to fix my injury. Here’s some of what I did for my ECU subluxation treatment. Note: this is NOT medical advice, just a retelling of my experiences.

Stabilize the ECU Tendon

I knew that repeatedly having my tendon slip out of place would prevent the nearby ligament from healing. Each time it pops out of place, the ligament is either stretched (if it is not torn) or the two ruptured ends are re-separated. Effectively, each subluxation re-injures this ligament. This kind of recurrent “trauma” renders any ECU subluxation treatment useless and ineffective.

The first thing I did to fix my subluxating ECU tendon was to prevent further snapping. This meant ceasing any activity or movement that did cause or may have caused any snapping. This also meant substantially less time in the gym.

I also had to immobilize my wrist for some time. I first started using basic wrist splints. After a while, I found WristWidgets. This product is a sort of wrist-wrap that applies pressure above and below the head of the ulna bone. This helped keep the ECU tendon from snapping by holding it “in place”, while giving mmy wrists more range-of-motion. These lasted me a few months until the velcro straps wore out.

Honestly, I think they’re a bit costly considering they’re just velcro wrist straps, but the WristWidgets definitely helped prevent further subluxation. I consider them to have been an important part of my ECU sublxuation treatment.  If you’re interested in the product, Amazon has WristWidgets for sale.

Wrist Widget - ecu subluxation treatment

In retrospect, the splints weakened the hell out of my wrist and grip strength. I wonder if the WristWidgets would have been better right off the bat. Oh well, we’ll never know.

Another tool that helped me prevent snapping of the ECU tendon was teaching myself to keep my wrist neutral at all times. I basically had to drill it in my head to not use excessive flexion, extension, ulnar deviation, and radial deviation, as extreme ranges-of-motion would increase the likelihood of snapping. This was essential in terms of my ECU sublxuation treatment, specifically with stabilization of the tendon.

Use Prolotherapy To Strengthen The Connective Tissue

In 2011, I found a medical doctor who offered me prolotherapy. In addition to having the ECU tendon subluxation, I also had lax wrist ligaments from excessive stretching.

In short, prolotherapy is a modality used by medical doctors to quicken (or start-up) the healing of connective tissue. An irritating solution is injected into the damaged areas, which causes an inflammation. Subsequently, tissue remodeling occurs. Here’s what a session of prolotherapy looks like…

 

I was unresponsive to the treatments at first, which was discouraging. However, months went by after receiving the treatments and my wrists felt more stable and resilient. Healing is a slow process, and you do what you can to facilitate it. In retrospect, I’m confident that prolotherapy sped-up my ECU subluxation treatment.

Gradually Reintroduce Movements and Exercises

As I mentioned before, I removed a bunch of movement as to prevent recurrent snapping in my wrist. This was done with the intention of being able to do everything again. Meaning, I wanted to lift heavy again.

When I began moving again, I found a lot of exercises to be uncomfortable and even painful. I did figure out, though, what was easiest to start with.

Static holds and exercises similar to them were the easiest in the beginning. Simply holding onto a gallon of milk or a bag of groceries was plenty difficult. This progressed to pulling-motions using a neutral grip, such as rows and pull-downs. I was stuck with these exercises for a while. It actually took me more than a year to get past this stage.

My wrists adapted and I eventually moved on to other things. This is the following order that I reintroduced wrist movements:

  1. Neutral gripping (e.g., static holds and dumbbell rows)
  2. Wrist flexion (e.g., wrist curls)
  3. Wrist extension (e.g., opposite of wrist curls)
  4. Radial deviation (e.g., tilting wrist towards the side of the thumb)
  5. Ulnar deviation and rotation in both directions.

I found ulnar deviation and rotation to be the most problematic when it came to recurrent subluxation of the ECU tendon. Thus, those movements were introduced last. I was already lifting heavy by the time they were re-introduced.

Avoidance of Extreme Ranges of Motion

Even today, I still do not push my wrist into extreme ulnar deviation. I’m not actually using my ECU tendon treatment “protocol” anymore, but I feel that avoiding extreme joint positions is still prudent.

I can count the number of times my ECU subluxates for the entire year on one hand. It is only when I accidentally venture into these extreme ranges-of-motion that I’ll ever feel a snap in my wrist. This doesn’t hinder me at all in my training. For a while, the only exercise I could not perform was the power clean. However, I’m able to do tit now.

In the End, My ECU Subluxation Treatment Worked

It was a long journey, but I was able to recover from my wrist injuries. If it weren’t for the strict adherence to my ECU subluxation treatment, I’m not too sure I would have improved at all. With a little guidance from a doctor plus some self-help, I did what I could have to fix my injury, and it worked.

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9 Comments

  1. Photo Credits
    Wrist X-ray. Source: MedPix Medical Image Database. commons.wikimedia.com

  2. I have the exact same injury. I have been contemplating surgery. It’s good to know you were able to manage ur injury and heal it without surgery. Thank you for the post it’s very helpful.

  3. You said you still get a relapse of the ECU subluxations less than 5 times a year. Can I take that to mean it was never fully healed. You only modify/adapt your wrist movements in order not to aggravate the condition?

    • Leekl,

      That’s right, although the ecu tendon is much more stable than it once was. I had to avoid ANY circumduction or ulnar deviation to avoid the subluxation. Now, I just need to avoid sudden/aggressive ulnar deviation while the hand is supinated (palms-up). Aside from that, my wrist is doing awesome. I’m happy with its current level of stability. I can deadlift, power clean, press, pushup, farmer’s carry, etc. just fine.

      My guess is that the sheath that holds in the ECU tendon is still somewhat lax, but tightened a bit over time.

  4. Hi,
    I have yet to have an MRI done. In the meantime, my symptoms are:
    When my hand is pronated or supinated, there is no subluxation of my ecu tendon. Only when I perform an active ulnar deviation like carrying and pouring a full water jug, that’s when I feel the ecu tendon run across my ulna and the wrist feel like it is giving way. Is that symptomatic of a ruptured sub-sheath? Apparently ruptured sub-sheaths needs reconstructive surgery, doesn’t it? Or can it heal naturally?

    • LeeKL,

      While I struggled with the same movements and everyday tasks, I was told mine was most likely NOT ruptured (I had prolotherapy under ultrasound and the doc based his claims off of that). From what I know, any soft-tissue damage can heal naturally if it isn’t a 100% rupture.

      You need to see a doctor who specializes in sports medicine or orthopedics, because I am not a medical professional and cannot give you the proper diagnosis.

      • Is prolotherapy effective? Is medically accepted or just alterntive medicine? How long after your injury before you tried prolotherapy? I mean, did you resort to prolotherapy after you have exhausted other conservative non-surgical treatments?

        • The medical insurance industry by large labels prolotherapy as “alternative”. However, many medical doctors use it in their practice. There have been a few studies showing somewhat favorable results for prolotherapy. Just look up “prolotherapy athletes” or “PRP athletes”. Many professional athletes have used it with success.

          That’s why doctors love to use prolotherapy so much – they get paid out of pocket for it and this therapy helps people out.

          I used conservative methods for a year and a half before resorting to prolotherapy.

          Again, you should probably see a doctor. If you are interested in getting prolotherapy, then seek out an orthopedic surgeon or sports medicine doctor who uses prolotherapy. A lot of times, these docs will use ultrasound to look at your soft-tissues right then and there to diagnose you and assess the severity of your injury. If you are in the USA, DOs tend to be more like this than MDs, but that’s just my personal experience. I saw both and MD and DO who gave me prolotherapy. Both were great.

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