Columbia University Irving Medical Center/NewYork Presbyterian Hospital, NY, USA.
Newton-Wellesley Hospital, MA, USA.
Hand (N Y). 2024 Sep;19(6):951-960. doi: 10.1177/15589447231151433. Epub 2023 Feb 13.
Extensor carpi ulnaris (ECU) subsheath injuries are an increasingly recognized cause of ulnar-sided wrist pain in elite athletes. There is a lack of surgical outcome data in elite athletes, and unique considerations exist for these patients.
We performed a retrospective review of our hand center experience of 14 elite professional or collegiate athletes who prospectively underwent radially based extensor retinacular sling ECU subsheath reconstruction by 3 hand surgery-fellowship-trained surgeons between April 2011 and April 2021. Clinical, magnetic resonance imaging (MRI), and intraoperative findings were cataloged. Subgroup analyses of elite hockey players and acute subsheath injuries were also conducted. Statistical analysis was performed via a 2-tailed paired test.
Mean age at the time of surgery was 21.3 years (range, 18-34). Mean time from symptom onset to surgery was 102.1 ± 110.7 days. All 14 patients underwent preoperative MRI. Five patients (35.7%) had intrinsic ECU tendinopathy, 9 patients (64.3%) had ECU tenosynovitis, 6 patients (42.9%) had triangular fibrocartilage complex tears, and 9 patients (64.3%) had ulnocarpal synovitis. Mean postoperative pain on a Visual Analog Scale was 0.25 ± 0.43. Grip strength ( = .001), wrist flexion-extension ( = .037), and pronosupination arcs ( = .093) showed excellent recovery postoperatively. Mean time to unrestricted return to sports was 92.5 ± 21.0 days. There were no complications. Subgroup analyses found similar functional improvement and characterized injury patterns.
Overall, our findings suggest surgical management of ECU subsheath injuries is a viable option in both acute and chronic settings in elite athletes and may be favorable compared with nonoperative management.
尺侧腕伸肌（ECU）下鞘损伤是精英运动员尺侧腕部疼痛的一种日益被认识的原因。在精英运动员中，缺乏手术结果数据，并且这些患者存在独特的考虑因素。
我们对我们手中心的经验进行了回顾性分析，共有 14 名精英专业或大学生运动员前瞻性地接受了由 3 名手部手术研究员培训的外科医生进行的基于桡侧的伸肌支持带 ECU 下鞘重建，时间在 2011 年 4 月至 2021 年 4 月之间。对临床，磁共振成像（MRI）和术中发现进行了分类。还对精英曲棍球运动员和急性下鞘损伤进行了亚组分析。通过双侧配对 t 检验进行了统计学分析。
手术时的平均年龄为 21.3 岁（范围 18-34 岁）。从症状出现到手术的平均时间为 102.1 ± 110.7 天。所有 14 名患者均接受了术前 MRI。5 名患者（35.7％）有固有 ECU 肌腱病，9 名患者（64.3％）有 ECU 腱鞘炎，6 名患者（42.9％）有三角纤维软骨复合体撕裂，9 名患者（64.3％）有腕尺侧滑膜关节炎。术后视觉模拟量表上的平均疼痛为 0.25 ± 0.43。握力（ =.001），腕屈伸（ =.037）和旋前旋后弧度（ =.093）术后均有极好的恢复。无限制重返运动的平均时间为 92.5 ± 21.0 天。没有并发症。亚组分析发现了相似的功能改善，并描述了损伤模式。
总体而言，我们的研究结果表明，在急性和慢性情况下，手术治疗 ECU 下鞘损伤在精英运动员中是一种可行的选择，与非手术治疗相比可能更有利。
