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

  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.

  5. Hi Mark,

    Just curious how many prolotherapy sessions you had before your wrist stopped popping, please let me know as I am booked for my first session soon and would like to know what to expect.


    • 6 brutal treatments on my worse hand, and 3 weak treatments plus 3 brutal treatments for my better hand.

      The so-called “brutal” treatments we’re performed using the most caustic solution available, injected into multiple sites, using a fluoroscope to ensure the shots were accurately precise. The weak treatments used a weaker solution in fewer injection sites that were performed “free-hand”; e.g., just based off of looking at my hand.

      Swelling was a bitch but it worked in the long-run. I’d do it all over again if I had to. I just wished the “brutal” sessions were cheaper. You get what you pay for, I guess.

  6. Is there anyway I can get in touch with you directly pleasd. I’m suffering from similar issue and need some input.

    • I have the same issue, instability of the wrist, ulnar side pain and diffuse irritation, and subluxation of the ECU tendon. An MRI shows the ECU is very dislocated at most times and the sub sheath is torn completely, allowing the ECU to rotate at will across the ulnar bone.

      Since my injury was caused by an at-fault driver hitting me in an automobile accident, I have opted for the surgical treatment, ECU subsheath reconstructive surgery. It’s amazing how subtle issues within joints and tendons can cause such life-changing problems. I am certainly looking forward to the surgery and post-operative treatment/PT. I expect a long road, but it shouldn’t be as bad as the past six months.

      Thank you for the journal entries here. It was good to read another’s treatments regarding the same issue.

      • That’s awesome that you were able to get surgery for it, because a complete rupture of the subsheath would probably mean life-long issues if it were untreated. Good luck with surgery and the post-op.

        • Mark,

          12 days post surgery, pin and stitches came out yesterday. Short cast below the elbow and a thumb brace (auto accident caused hyper extension of the thumb tendon as well, repaired and pinned in place). Although mobility is limited due to the arm cast, I can stretch within the cast’s confines. The instability feeling is gone, but the tendon is tight due to internal stitches from the sub-sheath repair (either side of ECU tendon). post op PT is going to be a bear.

          Things are looking up. Thanks again for the blog, It’s full of useful information.

          • Matthew,

            Glad to hear surgery went well. Don’t ever become discouraged during your recovery, as the damage is fixed and things can only improve from here on out. Best of luck to you!

  7. Hi again, I was trying to get in touch about ECU issues. I hurt both wrists. I’m getting different opinion from different hand surgeon about my issues and it’s so confusing. Also since my issue was work related, I have to strictly adhere to occupational doctors recommendations! I was not allowed to do prolotherapy. If you can please email me I have a few enquiries from you. Thanks 🙂

  8. I really appreciate this post. I have ECU subluxation in both wrists. I have worn a splint, and also tried the wrist widgets. For me, I find the wrist widgets causes more pain (could be due to area already being irritated).

    I had a steroid injection in both wrists. My hand surgeon says we could do another injection or surgery. I am wanting to avoid another steroid injection since since it did thin out the skin on my left wrist.

    Being a weight lifter, I find it hard not to lift. This is the main source of my subluxation. My physician says to do light weights, but…… I primarily focus on exercises that have my arms in neutral position, which there are few upper body exercises that allow such. I sometimes use ankle attachments on cable machines so it keeps me from utilizing my wrist, and puts the stress on the forearms as the lever. I basically live off of cold compresses and ibuprofen on my worse days.

    My questions, for you, is sleeping. I am a stomach/side sleeper and it is hard to keep my wrist in a neutral position. Of course, since I am rotating my ulna to get into a side sleeping position, I wake up with more pain. I have tried falling asleep on my back, but I end up waking up on my side with my wrist hurting. Do you have any recommendations on arm placement? I know this sounds strange…..but it does make my sleep less restful when I am tossing and turning from not getting my arms in an ideal position to sleep.

    Thank you!

  9. This is a slow injury to heal. IN order to start healing you must wear a wrist brace (from a pharmacy is fine) that will prevent you from turning, bending, moving your wrist. this will prevent the near constant micro trauma of normal life (or athletics! which must be stopped on that hand/wrist) and that will start the healing. I had this in Dec 2014 and prevented any healing by not wearing the brace…about a month later I started to wear it and it helped right away…Wear it all night and nearly all day…can remove it for an hour if watching TV for example but not moving wrist.

  10. addendum: I am almost 100% now but it took about 8 months. I am 44 so perhaps a young person will heal faster if they leave the wrist alone.

  11. For those who had surgery was it worth the pain etc. How was recovery? Does your ecu tendon feel stiff/tight?

  12. Hi,

    Glad to hear you’ve managed to get your subluxation under control. I’ve had surgery on my right ecu this year and so far it’s been stable but I still get a lot of aches and pains in it. I’m due to have the left one done on the 29th but unsure what to do now. I’ve put up with the left one as it is for 5 years now. Most of the time I get no pain when it pops. But, it’s still at least 5 times a day that it does so. There’s always a chance I could make it worse but could also be fixed by this time next year. What do you think the long term effects of the popping could be on the tendon?

  13. I also have the Ecu subluxation. I have been in wrist braces since the beginning of July and they have done absolutely nothing. Now I’m going for an MRI to determine how bad my case is. When I pop my wrist it’s only uncomfortable, not painful, I get the pain when I quickly rotate my hand from side to side, not popping it. Does anyone know how long the surgery process is?

  14. Hi
    Is the shot therapy safe for someone who has a baby size wrist, and frail bones. I myself have this its painful. Don’t know if surgery is the right route or the shots.i have carpel tunnel also.

    • Samantha, I am so sorry for never responding to your comments.

      I’d refer to a physician who can properly answer your question.

      All I know is that they use a tiny tiny needle to inject the irritants. I personally don’t see how or why it’d be bad for someone with tiny wrists.

  15. I have a 9 yr old Colles fracture and recent sustained a ECU injury. Your blog was very helpful. My hand surgeon gave me the stiff brace and told me to wear it for 6 weeks when everI did any heavy work to prevent re-injury. I ride horses and riding with a stiff brace is not easy. I bought the WristWidget after reading you suggestions and even with some wrist angulation from the fracture, the widget works very well. I do not have a TFCC tear but typing and other routine work things painful. The Widget has reduced that pain to nil. Another month will tell the story. I did have to make one modification – the video shows the Widget with the straps wrapping from the outside to inside of the wrist. When I did that, the Widget worked its way consistently “off” my wrist. I turned the Widget around so that the straps were facing outward and now it stays where I put it, even with different levels of pressure. Carolyn

    • Carolyn, that’s amazing to hear.

      I’m glad you made progress and got better. Cheers.

      • I had an ECU tear several years ago and had to have it done twice. The first “hand” surgeon didn’t have a clue how to perform the procedure. Dr. Lonnie Moskow. lol When he said after the surgery it wasn’t that bad but later on after a few steroid injections claimed there was nothing more “he” could do for me because he then said the damage was too severe, I looked up who performed hand surgery for the Los Angeles Dodgers. Dr. Norman Zemel. He took a flat xray and saw a suture anchor out of place and he went in to fix things. That anchor had almost completely severed my ulnar tendon. He removed the anchor and resewed the tendon and sheath. I healed up perfectly. I asked him later about the anchor and he said he did not use anchors for ECU repairs. He is retired now as he was in his 70’s when he fixed me. A word of advice. Find the hand surgeon to the sports teams in your area to make this repair even if you have to drive a distance. As far as “healing” an ECU it’s a fools errand. If your tendon is moving out of the slot and back in as you rotate your hand it’s a done deal. Get in and get it repaired.

  16. Hello Mark,
    My ECU injury has gotten better, but the tendon is not fully stable after 6 months of conservative treatmeant.
    During the past month my wrist cracks a lot and it feels like DRUJ instability. How was your experience regarding DRUJ instability ?
    I’d really appreciate your response.

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