Elbow, Wrist & Hand

What It Is

Tendonitis is when a tendon, the tissue connecting a muscle to bone, becomes swollen and painful (NHS, 2023). The extensor carpi ulnaris (ECU) tendon runs along the little-finger side of the wrist and is a common cause of pain on that side of the wrist (Satria, Aprilya and Hadinoto, 2025). The ECU straightens (extends) the wrist, bends it towards the little-finger side, and helps keep that side of the wrist stable, which is important when you grip and pull (Campbell et al., 2013).

ECU problems can affect the tendon itself (tendinopathy) or the lining around it (tenosynovitis). The lining, or sheath, normally produces a fluid that helps the tendon glide smoothly, but if it becomes inflamed, this function is impaired. Occasionally the tendon can tear (Campbell et al., 2013).

Extensor Carpi Ulnaris Tendonitis Anatomy

The ECU muscle sits on the back of the forearm on the little-finger (ulnar) side. Its tendon runs past the wrist and attaches to the base of the bone below the little finger (the fifth metacarpal) (Satria, Aprilya and Hadinoto, 2025). It works to extend the wrist and bend it towards the little-finger side (Campbell et al., 2013).

Not a diagnosis — for more information, contact me or another trusted healthcare provider.

Treatment

Self-Care & Treatment

How to Treat Extensor Carpi Ulnaris Tendonitis

Exercises are an important part of recovery: gentle exercises that work the muscle without moving the wrist while it's painful, then building the load up in stages, with strengthening for longer-term problems (Campbell et al., 2013). I can guide you through this with a graded exercise programme and hands-on work for your forearm and wrist. See the My Approach tab for how I work.

1. Rest and Activity Changes

Resting from the activities that bring on the pain, and changing how you do them, is the first step (Campbell et al., 2013). Try to avoid heavy lifting, strong gripping or twisting actions that make the symptoms worse, and avoid playing sport until the tendon has recovered (NHS, 2023).

2. Cold Therapy

Ice can help ease pain. Put an ice pack (or a bag of frozen peas) wrapped in a tea towel on the tendon for up to 20 minutes every 2 to 3 hours (NHS, 2023). Never put ice directly on the skin.

3. Medication

The NHS (2023) says a pharmacist can recommend the best painkiller, and that paracetamol and ibuprofen can help to ease pain; they may also recommend an ibuprofen gel to rub on the skin. (This medicine information comes from the NHS, not from me. Always check with a pharmacist or your family doctor or nurse practitioner before taking any medicine.)

Treatments you may want to discuss with your family doctor or nurse practitioner

Options outside my scope

Prescription painkillers: if you need treatment, you may be prescribed a stronger painkiller (NHS, 2023).
Splint or cast: a doctor or physiotherapist may fit a splint, or occasionally a cast, to rest the wrist in a position that protects the tendon (Campbell et al., 2013).
Physiotherapy: this may be offered if the pain is severe, lasts a long time or limits your movement (NHS, 2023).
Steroid injections: some people with severe tendonitis may be offered a steroid injection, which may give short-term pain relief (NHS, 2023).
Surgery: treatment is usually non-surgical, but surgery may be considered if this fails (Satria, Aprilya and Hadinoto, 2025).

How I can help (see the My Approach tab)

A graded exercise programme to load and strengthen the tendon
Hands-on work for the forearm and wrist
Advice on activity, technique, work set-up and taping

Tips

ECU problems are most often reported in tennis and golf, and can also happen in contact sports such as rugby league (Campbell et al., 2013).
Sudden, sharp movements and repetitive movements, or poor technique at work or in sport, can cause tendonitis (NHS, 2023).
Before beginning any activity, take the time to warm up properly, and gently stretch afterwards (NHS, 2023).
Take regular breaks from repetitive exercises and allow your body to recover before starting other activities (NHS, 2023).
Stop any repetitive movements that might be aggravating the tendonitis.
If the pain is sudden and severe, came on during an accident or activity, and you heard a popping or snapping sound, you may have torn (ruptured) the tendon (NHS, 2023). Get medical help promptly.

Treatment

My Approach

An irritated ECU tendon needs the right amount of load: enough to help it recover, not so much that it flares. My aim is to calm it down, build its tolerance back up, and change whatever overloaded it.

I start by assessing how your wrist and forearm move, your grip and wrist strength, which movements bring on the pain, and how you use your hand at work and in sport.

When It's Sore

I leave the sore tendon alone and work the forearm, upper arm and shoulder, including trigger points that refer pain towards the wrist
Gentle lymphatic drainage for swelling, and pain-free movement so the wrist doesn't stiffen
Warm or cool applications in the clinic, and I'll show you how to use ice safely at home
Gentle holds where the muscle works without the wrist moving
Taping to support the wrist, and I'll show you how to tape it yourself

As It Settles

Warm or contrast applications, then myofascial work and muscle stripping through the forearm
Cross-fibre work on tight, stuck spots around the tendon once it's no longer acutely painful, followed by a gentle stretch
Building the load in stages, from holds to light movement to slow lowering, within comfortable limits
Grip and forearm strength, building to gym-based work and a graded return to sport
A home programme between visits

We'll also adjust the task that caused it, whether that's your work set-up, a tool, your grip, or your racquet or club technique. If a wrist support might help, I'll help you work out what you need and how to get one.

If the pain is sudden and severe with a pop or snap, or your wrist suddenly goes weak, get medical help promptly, as the tendon may have torn.

What to Expect

Typical Course

Typical course: Most people come in once or twice a week for the first two or three weeks, then weekly, then less often as they manage more on their own, with a reassessment at about 4 to 6 weeks. Improvement usually starts within a few weeks, and recovery usually takes around 6 to 12 weeks, longer if the problem has been there for a while.

What I Focus On

Load Management

Forearm & Wrist Release

Progressive Tendon Loading

Grip Strength

Activity & Technique Changes

Sources

References

Campbell, D. et al. (2013) 'Sports-related extensor carpi ulnaris pathology: a review of functional anatomy, sports injury and management', British Journal of Sports Medicine, 47(17), pp. 1105-1111. doi: 10.1136/bjsports-2013-092835.
Satria, O., Aprilya, D. and Hadinoto, S.A. (2025) 'Ulnar-sided wrist pain: systematic clinical approach and principles of treatment', Orthopedic Research and Reviews, 17, pp. 199-212. doi: 10.2147/ORR.S506374.
NHS (2023) Tendonitis. Available at: https://www.nhs.uk/conditions/tendonitis/ (Accessed: 8 October 2026).

Massage therapy · Kitchener–WaterlooExtensor Carpi Ulnaris Tendonitis (ECU)

What It Is

Extensor Carpi Ulnaris Tendonitis Anatomy

Self-Care & Treatment

How to Treat Extensor Carpi Ulnaris Tendonitis

1. Rest and Activity Changes

2. Cold Therapy

3. Medication

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

When It's Sore

As It Settles

Typical Course

References

Related Conditions

Book a session

Massage therapy · Kitchener–WaterlooExtensor Carpi Ulnaris Tendonitis (ECU)

What It Is

Extensor Carpi Ulnaris Tendonitis Anatomy

Self-Care & Treatment

How to Treat Extensor Carpi Ulnaris Tendonitis

1. Rest and Activity Changes

2. Cold Therapy

3. Medication

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

When It's Sore

As It Settles

Typical Course

References

Related Conditions

Bowler's Thumb

Carpal Tunnel Syndrome

Cyclist's Palsy

De Quervain's Tendonitis

Book a session