Extensor carpi radialis rehab and wrist flexibility | The MSK Physio

Extensor carpi radialis rehab and wrist flexibility | The MSK Physio

The extensor carpi muscles consist of three muscles within the extensor compartment of the forearm. This is the backside or back of the hand side. The extensor carpi radialis muscles consist of the longus and brevis which attach to the back of the palm at the second and third metacarpals respectively (1). The extensor carpi ulnaris attaches to the fifth metacarpal. Together the three, along with other muscles attach up at the lateral elbow and humerus, or common extensor origin. They share wrist extension roles with the extensor digiti minimi and extensor digitorum, muscles that extend the fingers. Individually the ECRL/B and ECU will move the wrist sideways into deviation. This isn’t covered within this video.

The ECR muscles play a role in lateral elbow pain, also known as tennis elbow or lateral epicondylalgia. Interestingly, research is starting to show that even with no treatment input, individuals will spontaneously resolve over 12 months (2). On average, pain and disability reduced by 50% every 3 to 4 months, with up to 88% resolution within 12 months. Essentially, this condition looks to be a self-limiting condition. As the authors conclude, surgery, a common intervention for persistent lateral elbow pain, may not be needed! (2,3).

So where does exercise fit into this? Eccentric options definitely are effective in reducing pain and disability and may be better than concentric options over 3 to 6 months (4,5). Ultimately, both improve symptoms.

Today’s video discusses two wrist extension exercises with some options to help bias the elbow.



Intro - 0:00
Exercise principles - 0:56
Anatomy of extensor muscles - 1:45
Wrist flexibility tests - 2:45
Tennis elbow - 3:21
Passive and active insufficiency - 4:33
Exercise #1 - Wrist pushups - 5:20
Wrist pushup regression - 7:08
Exercise #2 - Dumbbell extension - 9:09
Exercise modifications - 10:20
Rehab considerations - 12:33
Case study - 14:07
Summary - 15:34
Outro - 16:42


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References:
1. Marieb EN, Hoehn K. Human Anatomy & Physiology. 9 edition. Boston: Pearson; 2012. 1264 p.
2. Ikonen J, Lähdeoja T, Ardern CL, Buchbinder R, Reito A, Karjalainen T. Persistent Tennis Elbow Symptoms Have Little Prognostic Value: A Systematic Review and Meta-analysis. Clinical Orthopaedics and Related Research®. 2022 Apr;480(4):647.
3. Bateman M, Littlewood C, Rawson B, Tambe AA. Surgery for tennis elbow: a systematic review. Shoulder & Elbow. 2019 Feb;11(1):35–44.
4. Peterson M, Butler S, Eriksson M, Svärdsudd K. A randomized controlled trial of eccentric vs. concentric graded exercise in chronic tennis elbow (lateral elbow tendinopathy). Clin Rehabil. 2014 Sep 1;28(9):862–72.
5. Cullinane FL, Boocock MG, Trevelyan FC. Is eccentric exercise an effective treatment for lateral epicondylitis? A systematic review. Clin Rehabil. 2014 Jan;28(1):3–19.

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