ECU tendinitis

Hi MP,

I developed and was diagnosed with tendinitis in my ECU (extensor carpi ulnarnis) tendon. It is a result of overuse at my job, but I’m sure climbing doesn’t help it either.

My ortho wants to administer a steroid shot next month when I’m able to take a few weeks off work. My questions are these to anyone that has dealt with this before: 

1. How were your outcomes if you received/did not receive a steroid injection?

2. What was your rehab/prehab routine like?

3. How long did you take off from climbing (if at all)?

Thank you!

I am having the same issue - brought on likely by trauma from shattering my wrist last year.  

My doctor said a steroid injection should be the last resort as it's likely he would only inject it once, so he prefers I try conservative treatment.  So I am on oral anti-inflammatories as well as doing OT 1x/week with some stretches & exercises.  It seems to be getting better slowly....  

I have had elbow tendinitis in the past (golfer's elbow), so know it can take awhile to calm down.  Given it is improving I'm hoping I can avoid a steroid injection. 

FYI I am not climbing at all until it heals. 

I once did the steroid shot because I had a climbing trip planned. After initial soreness it worked and I went on the trip. I started doing pt exercises after the trip while cortisone was still in effect and I think that cured the problem before cortisone wore off. Now if I even sense elbow pain I break into my routine daily for a while. 

I've been dealing with ECU tendinopathy since 2022 after overtraining (board climbing + hangboard without enough rest days). I got no effect from a steroid shot except a temporary pain flareup. Orthos love to give cortisone shots but it is now becoming understood that "tendinitis" is often a misnomer because minimal inflammation is involved; instead tendons go through a process of reactivity and degeneration when consistently overloaded. Appropriate loading, conversely, strengthens/remodels/rebuilds. Cortisone suppresses inflammation, so it can help with many issues but often doesn't have lasting benefits. Also, research suggests it can interfere with tendon remodeling so it can actually be counterproductive for tendon issues.

What did help me was to stop pushing through the pain thoughtlessly and gradually re-introduce stimulus including climbing. I found a good hand therapist to help me through this process. I did pretty standard rehab, most importantly strengthening wrist extension -- again very gradually. Good physical/occupational therapists always seem to use the motto "let pain be your guide." If it hurts during, after, or the next day, it's probably too much for the moment. Otherwise movement/loading is generally positive. Total deload can lead to atrophy — the tricky part is striking the right balance. (I personally made the mistake of going too far in both directions.)

By the end of 2022 I was climbing again, and have continued to do so without major issues. I don't rehab anymore apart from warming up for climbing with bands. I did find that computer work continued (and continues) to irritate it, though actually climbing sometimes makes it feel better now. I just started a course of ESWT treatments, which have some good research behind them -- the jury's still out on that one, but I can report back.