Virginia Via Research Day Book 2026

Medical Student Research Case Reports

29 EXTENSOR CARPI ULNARIS SPLIT TEAR IN A COLLEGIATE FEMALE GOLFER: A CASE REPORT

Neal Patel, OMS-III, Brett Brodsky, DO, Del Bolin, MD, Chad Hyatt, ATC Corresponding author: npatel09@vcom.edu

Radford University, Radford, Virginia VCOM-Virginia, Blacksburg, Virginia

This report describes a 23-year-old right-handed collegiate female golfer who presented with right wrist pain and diagnosed with an Extensor Carpi Ulnaris (ECU) tendon split tear. This case highlights a rare case of ECU pathology and the management of her injury utilizing platelet-rich plasma (PRP). Our hypothesis is that this injury resulted from exaggerated wrist extension and repetitive forearm supination. While incidences of ECU tendonitis or ECU tendon subluxation are well described, ECU tendon split tears are much rarer with little epidemiological data. The athlete initially presented with a 3-month history of progressively worsening right ulnar-sided wrist pain. The wrist pain worsened to the point of withdrawing from a tournament. She denied any trauma to the wrist but admitted to increased discomfort during her downswing and follow-through phases. Additional symptoms of clicking and reduced power during striking motion were expressed. Physical exam revealed tenderness between the trapezium and trapezoid dorsally and in the first webspace without limitations in range of motion or strength within her fingers and thumb.

Palpation over carpal bones showed restricted motion of the trapezoid which appeared to be dorsally rotated and angulated along the distal aspect in the direction of the thumb. X-ray imaging of the right wrist demonstrated no fractures or dislocations but did show an asymmetrically seated trapezoid on both anterior-posterior and oblique views. Magnetic resonance imaging (MRI) showed no evidence of intrinsic ligamentous injury but did show ECU tendinosis with a longitudinal split tear just proximal to the pisiform. Patient failed initial management of osteopathic manipulation, non-steroidal anti-inflammatory drugs (NSAIDs) and rehabilitation. Given the small area of the split tear, a platelet rich plasma (PRP) injection procedure was done under ultrasound guidance to facilitate healing. Afterward, a comprehensive rehab protocol in combination with swing adjustments were implemented. ECU tendon injuries are commonly seen in sports that involve gripping of an implement, such as a golf club, tennis racquet or bat. The ECU tendon is under maximal stress when the wrist is supinated, flexed, and ulnarly deviated, which are all common repetitive motions seen

in golfers. One study that surveyed 153 professional golfers reported that all traumatic ECU tendopathy cases involved the “leading” wrist, which in a right handed golfer would be the athlete’s left hand. However, in this case report, the athlete injured her right hand also known as her “trailing” wrist. Furthermore, the athlete developed more thumb sided pain, which was likely exacerbated due to compensation from the ECU tendon split tear. Also, given that ECU tendon split tears are rare, management of these injuries have not been established. This case presents a rare case of an Extensor Carpi Ulnaris tendon split tear of a collegiate level athlete diagnosed via MRI. Given the risk of tendon rupture associated with steroid injections, PRP was injected into the area to facilitate healing. The athlete will continue to progress through her customized rehab protocol with anticipated return to sport.

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2026 Research Recognition Day