Abstract
The pain of flexor carpi ulnaris tendinitis is constant and severe and is localized to the dorsoulnar aspect of the wrist. The patient suffering from flexor carpi ulnaris tendinitis often complains of sleep disturbance owing to pain. Patients with flexor carpi ulnaris tendinitis exhibit pain with active resisted flexion of the hand and with radial deviation of the wrist. In an effort to decrease pain, patients suffering from flexor carpi ulnaris tendinitis often splint the inflamed tendon by limiting hand flexion and radial deviation of the wrist to remove tension from the inflamed tendon. If untreated, patients suffering from flexor carpi ulnaris tendinitis may experience difficulty in performing any task that requires flexion and adduction of the wrist and hand such as using a hammer or lifting a heavy coffee mug. Over time, if the tendinitis is not treated, muscle atrophy and calcific tendinitis may result, or the distal musculotendinous unit may suddenly rupture. Patients who experience complete rupture of the flexor carpi ulnaris tendon will not be able to fully and forcefully flex the hand or fully adduct the wrist.
Keywords
flexor carpi ulnaris tendinitis, wrist pain, tendinopathy, thedinitis, carpal boss, sports injuries, diagnostic sonography, ultrasound guided procedures, pisotriquetral arthritis
ICD-10 M65.849
The Clinical Syndrome
The flexor carpi ulnaris tendon of the hand may develop tendinitis after overuse or misuse, especially when performing activities that require repeated flexion and adduction of the hand. Acute flexor carpi ulnaris tendinitis has been seen in clinical practice with increasing frequency owing to the increasing popularity of racquet sports such as tennis, baseball, and golf ( Fig. 51.1 ). Improper stretching of flexor carpi ulnaris muscle and flexor carpi ulnaris tendon before exercise has also been implicated in the development of flexor carpi ulnaris tendinitis, as well as acute tendon rupture. Injuries ranging from partial to complete tears of the tendon can occur when the distal tendon sustains direct trauma while it is fully flexed under load or when the wrist is forcibly flexed while the hand is full radial deviation.
Signs and Symptoms
The pain of flexor carpi ulnaris tendinitis is constant and severe and is localized to the dorsoulnar aspect of the wrist. The patient suffering from flexor carpi ulnaris tendinitis often complains of sleep disturbance owing to pain. Patients with flexor carpi ulnaris tendinitis exhibit pain with active resisted flexion of the hand and with radial deviation of the wrist. In an effort to decrease pain, patients suffering from flexor carpi ulnaris tendinitis often splint the inflamed tendon by limiting hand flexion and radial deviation of the wrist to remove tension from the inflamed tendon. If untreated, patients suffering from flexor carpi ulnaris tendinitis may experience difficulty in performing any task that requires flexion and adduction of the wrist and hand such as using a hammer or lifting a heavy coffee mug. Over time, if the tendinitis is not treated, muscle atrophy and calcific tendinitis may result, or the distal musculotendinous unit may suddenly rupture. Patients who experience complete rupture of the flexor carpi ulnaris tendon will not be able to fully and forcefully flex the hand or fully adduct the wrist.
Testing
Plain radiographs are indicated in all patients who present with wrist and hand pain ( Fig. 51.2 ). Based on the patient’s clinical presentation, additional testing may be indicated, including complete blood cell count, sedimentation rate, and antinuclear antibody testing. Magnetic resonance imaging or ultrasound imaging of the wrist and hand is indicated if flexor carpi ulnaris tendinopathy or tear is suspected. Magnetic resonance imaging or ultrasound evaluation of the affected area may also help delineate the presence of calcific tendinitis or other hand pathology ( Figs. 51.3 and 51.4 ).
