The extensor carpi radialis longus (ECRL) tendon occupies the second dorsal wrist compartment (alongside the ECRB) and inserts on the dorsal base of the second metacarpal. It is the more radial and more proximal of the two radial wrist extensors, originating from the lateral supracondylar ridge of the humerus above the common extensor origin. The ECRL is a powerful wrist extensor and radial deviator.
The ECRL tendon is the most commonly harvested wrist extensor for tendon transfer in high radial nerve palsy — as the most proximal and most powerful wrist extensor it is sometimes spared in isolated posterior interosseous nerve palsy, making it available as a donor for finger extension transfer (ECRL to EDC transfer). In De Quervain tenosynovitis surgery, the ECRL and ECRB are distinguished from the APL and EPB in the first compartment by their dorsoradial position. ECRL tendinopathy at the lateral epicondyle may contribute to lateral epicondylitis alongside the dominant ECRB tendinopathy.
High radial nerve palsy paralysing all wrist and finger extensors is treated by triple tendon transfer: ECRL to EDC (restoring finger extension), palmaris longus to EPL (restoring thumb IP extension), and pronator teres to ECRB (restoring wrist extension); the ECRL is chosen as the EDC donor because of its size match and its position in the second dorsal compartment.
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