Seeking ECU Tendon or Ligament Tear (Ulnar, Right Wrist) Advice

Hi MP Community,

I injured my right wrist in the climbing gym at the beginning of April 2022. Likely when holding a big right hand pinch horizontally (typically my pinky finger curls too) to move out to a low, left handhold. I didn't notice until I went to place my hand on another hold/problem later on.

This is my timeline:

• Injured wrist in early April at the climbing gym
• Woke up next morning with moderate pain and tenderness and some swelling that lasts 7-10 days
• First 1-3 weeks, took time off climbing but continued regular fitness including lifting weights (hand in curled position with weights does not hurt)
• First 1-2 months, gradually incorporated climbing back in - climbing v0-v3 outdoors, v0-v5 indoors on a kilter board
• Month 2, sought PT and was given wrist flexion exercises with a band, went to a couple in-person sessions with the similar PT exercises (nothing "advanced" it seemed)
• Month 3, climbing regularly and managing with the wrist - sometimes it takes a little extra time to warm up my wrist, and a little extra time off to avoid that feeling of "stiffness" from potential overuse, but never any significant pain (mild at best)
• Nearly 4 months later, I finally saw an Ortho just yesterday (appointments were not readily available, had to wait 1+ months), who suggested it may be a ligament or ECU tendon potentially (no issues revealed via X-ray); they suggested a wrist widget, Voltaren gel 4x daily and PT at their office (which they suggested some modality PT too) for 6 weeks and then potential steroid injection or MRI

I've pinpointed the pain to when my right palm is supinated and has weight applied to/against it. For example, having a flat supinated palm and trying to lift a table or a cast iron pan with it (but not flexing the wrist). It's a very specific pain that I do feel like I've lost power to lift what previously seemed doable/normal without thinking about it.

Curious if anyone has any advice on steroid injections for this type of wrist injury. I'm highly avoidant of injections of any kind and prefer the conservative method of exploring all other, less invasive options first. My initial thoughts are to have the MRI done in 6 weeks to at least have a better, more concrete diagnosis. It also seems that wrist injuries take quite some time to heal, so would be curious to hear about others' experiences.

Thanks for reading,

Christie

Tennis Players and Water Polo Athletes Now Have Something in Common to Talk About: MRI Findings of Extensor Carpi Ulnaris Chronic Subsheath Injury.
Gupta N, Bhatt N, Bansal I, Li S, Kumar Y.Cureus. 2018 Apr 16;10(4):e2489. doi: 10.7759/cureus.2489.

Treatment of subacute/chronic ECU tendinopathy using wrist arthroscopy and open surgical repair.
Lee YK.J Orthop Surg (Hong Kong). 2022 Jan-Apr;30(1):23094990211067009. doi: 10.1177/23094990211067009.

Extensor carpi ulnaris injuries in tennis players: A study of 28 cases. 

I didn't review these articles, but they are open access; perhaps there is something helpful in them.

Did you ever find out what caused the pain. I have the same symptoms. Pain when lifting palm face up and less of strength, can't lift certain things.

Hi Kyle, the cause was climbing in the gym. Some pinch move that I guess didn’t settle well.  My PT did an X-ray, but recommended regular PT sessions before an MRI. I did basic OT style therapy and time healed the rest. I am climbing normally now, despite a pulley injury on the same hand last year. Never properly diagnosed.

I think the Climbing Doctor has some good articles and/or videos on ECU, TFCC and other wrist related injuries.

Best of luck in your recovery. Let time take its course.