How do I heal from ECU subluxation from sheath?

Written by amanda goldfarb
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How do I heal from ECU subluxation from sheath?
ECU injuries are common among tennis players (tennis player image by Snezana Skundric from

Originating at the border between the ulna and humerus, and extending down the length of the arm to the fifth metacarpal; the Extensor Carpi Ulnaris (ECU) tendon is responsible for the extension and adduction of the wrist. A protective fibrous sheath holds the ECU in place. Any disruption of the fibrous sheath is referred to as a rupture. The tendon, now unsupported, is free to move in the wrist cavity. This condition is very painful and dangerous because the tendon has the potential to become entrapped within the wrist cavity. The patient needs surgery to repair the rupture followed by intensive physiotherapy to rebuild the surrounding muscle.

Skill level:

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Things you need

  • Medical tape
  • Splint
  • Wrist wrap

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  1. 1

    Immobilise the arm for three to four months post surgery or injury to ensure the tendon has time to heal. An ulnar blocking splint is the normal protocol because it blocks the movement of the ulna. Other splints can be used, as long as the arm remains completely immobilised.

  2. 2

    Inspect arm and wrist for any signs of swelling or bruising. Inflammation of the tendon is the most obvious sign the tendon has not healed. Palpate the wrist to check for pain or tenderness. Some tenderness is normal, but sharp or shooting pain may indicate a deeper problem.

  3. 3

    Start your wrist exercise routine slowly. You will have a significant range of motion loss since your wrist had been immobilised for such a long period of time. A good beginning exercise is wrist extension. Place your forearm and wrist on a flat surface. Using your other hand lift the hand from the injured wrist and slowly push it back toward your body. Do not force the hand back; it will take time to rebuild the flexibility.

  4. 4

    Place your forearm on a flat surface with your palm facing down. Using the other hand, move the hand on your injured wrist from left to right. These are radial deviation exercises. Once you have built up the strength of the wrist you can add a small weight to continue to challenge yourself.

  5. 5

    Wrap the wrist to protect and support it whenever you are using it for a strenuous task. Place the wrist in a neutral position, which is palm down and arm straight. Using an elastic wrist wrap or medical tape, wrap the wrist in a circular motion. You can add support by placing a few strips of tape in a horizontal pattern.

Tips and warnings

  • Consult a doctor if you feel a significant increase of pain while performing any of the exercises.

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