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Group 2 (n = 11) had their dorsal ulnar-sided wrist pain reproduced by the ECU synergy test and denied any discomfort with exam maneuvers that stressed intra-articular DiscussionĬhronic dorsal ulnar-sided wrist pain has been described as the low back pain of the wrist because of the elusiveness of a specific diagnosis and the refractory nature of the pain. Group 1 (n = 21) had no pain with the ECU synergy test but had reproduction of pain with exam maneuvers that stressed intra-articular structures. Scrutiny of the data revealed 3 groups of patients. The presence of both flexor carpi ulnaris (FCU) and ResultsĮMG evaluation of both of the authors during the synergy test demonstrated active muscle contractions of both the ECU and FCU muscles. The patient then radially abducts the thumb against resistance. Facing the patient, the examiner grasps the patient's thumb and long finger with one hand and palpates the ECU tendon with the other hand.
#Synergy fcu full
The wrist is held in neutral position with the fingers in full extension (Fig. The ECU synergy test is performed by having the patient rest his or her arm on the examining table with the elbow flexed 90° and the forearm in full supination. Ten patients had recurrent symptoms, of which 6 patients demonstrated ulnocarpal pathology by MRI and/or wrist arthroscopy. Of these, 7 patients remained asymptomatic at latest follow-up, confirming the diagnosis of ECU tendonitis. Seventeen patients had greater than 90% pain relief after injection. All 5 patients had ulnar-sided intra-articular pathology confirmed by MRI and/or arthroscopy. After ECU sheath injection, 5 patients had persistent discomfort with either lunotriquetral ballottement or triangular fibrocartilage complex compression. The remaining 22 patients (group 3) had positive synergy tests and exams that suggested concomitant ulnar-sided intra-articular pathology. Six patients experienced temporary improvement and had MRI evaluation, confirming the diagnosis of isolated ECU tendonitis in 5 of the 6 patients. All had greater than 90% pain relief after ECU tendon sheath injection 5 patients remained pain free. Eleven patients (group 2) had positive synergy tests and no pain with the remainder of the exam. All had ulnar-sided intra-articular pathology on MRI and/or arthroscopy. Twenty-one patients (group 1) had no pain with the synergy test but had exams suggesting ulnar-sided intra-articular pathology. Fifty-five patients met inclusion criteria.