The ECU occupies the sixth extensor compartment, the most medial compartment, in a groove between the ulnar styloid and the ulnar head. Its position changes with forearm rotation — ECU moves ulnar and dorsally in supination and radially and plantarly in pronation. This dynamic positional change within the groove is stabilised by the ECU subsheath. ECU tendinopathy from repetitive wrist extension-ulnar deviation loading (golf, tennis, racket sports) produces sixth compartment pain.
Wrist extension and ulnar deviation; dynamic DRUJ stabiliser through its groove relationship with the ulnar head
ECU tendinopathy presents as dorsal ulnar wrist pain reproduced by resisted wrist extension-ulnar deviation and during the follow-through of a golf or tennis stroke. The dynamic ECU subluxation test (active wrist motion in the supinated, ulnar-deviated position) reproduces the snapping and pain of ECU subsheath tears. Corticosteroid injection within the sixth compartment provides diagnostic confirmation.
Sixth extensor compartment overuse in racket and golf sports producing dorsal ulnar wrist pain managed with activity modification and injection.
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