The Upper Hand: Chuck & Chris Talk Hand Surgery Pearls and Challenges: Carpal tunnel, practice efficiencies, and the ulnar wrist
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Aug 31, 2025 Dive into the complexities of treating the ulnar wrist and managing carpal tunnel with practical pearls shared by listeners. Discover effective techniques for ECU tendonitis and wrist assessments, along with the importance of thorough patient preparation and surgical scheduling. The hosts share a humorous take on unexpected alarms and highlight community feedback that shapes their conversations. Tune in for surgical insights and tips, including innovative uses of tools for better outcomes.
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ECU Injection: Go Proximal And Limit Doses
- When injecting suspected ECU tendonitis, place the steroid at least 1 cm proximal to the wrist joint and aim to avoid intratendinous placement.
- Limit ECU steroid injections to a single shot to reduce risk of local fat atrophy and tendon issues.
Use The ECU Synergy Test
- Use the ECU synergy test to reproduce ulnar-sided pain by resisted finger adduction with the forearm supinated at 90 degrees.
- Positive reproduction of pain suggests ECU tendonitis and guides targeted injections or therapy.
Try A Wrist Widget Early
- Try a neoprene 'wrist widget' to support the ulnar side; it often relieves symptoms across multiple ulnar pathologies.
- Use it as a diagnostic and therapeutic tool, but recognize it can mask the exact diagnosis.