The extensor carpi radialis longus (ECRL) tendon occupies the second dorsal wrist compartment alongside the ECRB, lying more radial and superficial, and inserts on the dorsal base of the second metacarpal. Its muscle arises from the lateral supracondylar ridge of the humerus above the common extensor origin and becomes tendinous in the distal third of the forearm. The ECRL is a powerful wrist extensor and radial deviator.
| Muscle | |
|---|---|
| Attachment | Dorsal base of the second metacarpal |
Extends and radially deviates the wrist
Intersection syndrome occurs in the distal forearm, about 4-8 cm proximal to the wrist, where the APL and EPB cross over the ECRL and ECRB, producing pain, swelling and sometimes crepitus in rowers, canoeists and weightlifters; splinting and corticosteroid injection are first-line. The ECRL is supplied by the radial nerve above the elbow and is spared in posterior interosseous nerve palsy, so wrist extension is preserved but deviates radially. ECRL activity is tested by resisted wrist extension with radial deviation, whereas ECRB acts in neutral. In de Quervain tenosynovitis surgery, the ECRL and ECRB are distinguished from the APL and EPB in the first compartment by their dorsoradial position.
Friction where the first compartment thumb tendons cross the radial wrist extensors in the distal forearm, producing dorsoradial forearm pain and crepitus with repetitive wrist movement, managed with splinting, activity modification and injection.
Overuse tendinopathy of the ECRL producing dorsoradial wrist pain with grip and resisted wrist extension in radial deviation, managed with load modification and progressive strengthening.
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