Subscribe to RSS
DOI: 10.1055/a-2622-5102
Radial- versus Ulnar-Based Extensor Retinaculum Reconstruction for Extensor Carpi Ulnaris Instability: A Cadaveric Study
Funding Grant #22_010 from the Orthopaedic Scientific Research Foundation was used to fund this project.

Abstract
Background
Extensor carpi ulnaris (ECU) instability can be treated with subsheath reconstruction using the extensor retinaculum (ER). This cadaveric study studied two described techniques of radial- (RBR) and ulnar-based (UBR) extensor retinaculum reconstruction of the ECU subsheath.
Materials and Methods
The ECU subsheath and ER were exposed on 12 fresh frozen arms. Transverse and oblique RBR and UBR based on the ulnar aspect of the fifth dorsal compartment were created and measured. The transverse RBR and UBR were elevated from the ulnar aspect of the ulnar styloid and Lister's tubercle, respectively. The oblique RBR and UBR were elevated from the insertion of the retinaculum onto the flexor carpi ulnaris and the radial border of the second dorsal compartment, respectively.
Results
The mean styloid to styloid width for the ER was 50.3 ± 1.8 mm. Mean proximal to distal retinacular height was found to be 30.6 ± 2.0 mm. The mean transverse UBR (26.1 mm) was longer than the mean transverse RBR (18.3 mm), and the mean oblique UBR (36.0 mm) was longer than the mean oblique RBR (21.6 mm). All reconstructions were long enough to wrap around the ECU tendon and prevent the tendon from subluxating palmarly with wrist supination, ulnar deviation, and flexion.
Conclusion
In this cadaveric model, UBR and RBR of the ECU subsheath were sufficient to stabilize the ECU tendon, but UBR were significantly longer than RBR. Both reconstructions pull the ECU radially in pronation.
Publication History
Received: 17 October 2024
Accepted: 26 May 2025
Article published online:
23 June 2025
© 2025. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Byrd JN, Sasor SE, Chung KC. Extensor carpi ulnaris subluxation. Hand Clin 2021; 37 (04) 487-491
- 2 Inoue G, Tamura Y. Surgical treatment for recurrent dislocation of the extensor carpi ulnaris tendon. J Hand Surg [Br] 2001; 26 (06) 556-559
- 3 Inoue G, Tamura Y. Recurrent dislocation of the extensor carpi ulnaris tendon. Br J Sports Med 1998; 32 (02) 172-174
- 4 Ghatan AC, Puri SG, Morse KW, Hearns KA, von Althann C, Carlson MG. Relative contribution of the subsheath to extensor carpi ulnaris tendon stability: implications for surgical reconstruction and rehabilitation. J Hand Surg Am 2016; 41 (02) 225-232
- 5 Puri SK, Morse KW, Hearns KA, Carlson MG. A biomechanical comparison of extensor carpi ulnaris subsheath reconstruction techniques. J Hand Surg Am 2017; 42 (10) 837.e1-837.e7
- 6 Mastroianni MA, Leibman M, Belsky M, Vitale MA, Ruchelsman DE. Radially based extensor retinacular sling reconstruction for extensor carpi ulnaris subsheath injuries in elite athletes. Hand (N Y) 2024; 19 (06) 951-960
- 7 Verhiel SHWL, Özkan S, Chen NC, Jupiter JB. Long-term outcomes after extensor carpi ulnaris subsheath reconstruction with extensor retinaculum. Tech Hand Up Extrem Surg 2020; 24 (01) 2-6
- 8 Ruchelsman DE, Vitale MA. Extensor carpi ulnaris subsheath reconstruction. J Hand Surg Am 2016; 41 (11) e433-e439
- 9 Shoap SC, Dennis ER, Lombardi JM, Wilkerson J, Wahood M, Rosenwasser MP. An analysis of extensor carpi ulnaris groove morphology and tendon instability. Hand (N Y) 2024; 19 (03) 400-406
- 10 Pratt RK, Hoy GA, Bass Franzcr C. Extensor carpi ulnaris subluxation or dislocation? Ultrasound measurement of tendon excursion and normal values. Hand Surg 2004; 9 (02) 137-143
- 11 Wang C, Gill IV TJ, Zarins B, Herndon JH. Extensor carpi ulnaris tendon rupture in an ice hockey player: a case report. Am J Sports Med 2003; 31 (03) 459-461
- 12 Xarchas KC, Leviet D. Non rheumatoid closed rupture of extensor carpi ulnaris tendon. Report of a case in a professional athlete. Acta Orthop Belg 2002; 68 (04) 399-402
- 13 Spinner M, Kaplan EB. Extensor carpi ulnaris. Its relationship to the stability of the distal radio-ulnar joint. Clin Orthop Relat Res 1970; 68 (68) 124-129
- 14 Iwamoto A, Morris RP, Andersen C, Patterson RM, Viegas SF. An anatomic and biomechanic study of the wrist extensor retinaculum septa and tendon compartments. J Hand Surg Am 2006; 31 (06) 896-903
- 15 Salman SS, Ullah M. The attachments of the lateral and medial ends of the extensor retinaculum of the human wrist. Acta Anat (Basel) 1985; 122 (03) 185-186
- 16 Taleisnik J, Gelberman RH, Miller BW, Szabo RM. The extensor retinaculum of the wrist. J Hand Surg Am 1984; 9 (04) 495-501
- 17 Pevny T, Rayan GM, Egle D. Ligamentous and tendinous support of the pisiform, anatomic and biomechanical study. J Hand Surg Am 1995; 20 (02) 299-304