A very pleasant 24-year-old patient presented to me a month and a half ago. Despite his utter frustration and displeasure with his current medical condition, he methodically explained to me, that he had a cut to his wrist 2 months prior and has been unable to grip anything and his wrist was painfully popping anytime he tried to move it. He had no strength to grip anything at work and could no longer go to the gym. This injury reduced the life of a jovial 24 year old to a “miserable couch potato” (in his own words).

I examined the patient and immediately noted that the patient, when moving his wrist up and down, experienced asymmetric motion and painful clicking in the right wrist. A 5cm poorly healed previously stitched laceration graced the top of his wrist and was very painful to touch. An immediate diagnosis of a wrist extensor tendon rupture became evident (Extensor Carpi Ulnaris Tendon – ECU). This tendon extends and deviates the wrist into the position where grasp becomes comfortable and powerful. Absent in this patient, the function of the tendon nearly paralyzed the patient’s functional abilities of the hand by affecting the normal biomechanics of wrist motion causing a painful instability while moving the wrist.

Patient explained to me, that he had 2 months of occupational and physical therapy that did not improve his function one bit. This was, because he had an MRI that showed a partial tear of the tendon and not complete. I reassured the patient that his diagnosis was clear and he needed surgery to restore the normal balanced motion of the wrist. Unfortunately, because it has been two months since his injury, a simple repair was not possible. I chose a classic tendon transfer to restore the function of the ECU tendon. By harvesting one of the other tendons that extend the wrist (ECRL) and transferring it to the cut one (ECU), the course of the donor tendon gets redirected to closely emulate the normal pull of the ECU tendon and sufficiently matches the normal tendon excursion pattern and strength. This is the general principle of tendon transfers that each hand surgeon follows.

Today, at 5 weeks after surgery, this patient is as happy as can be with a full range of motion of the wrist and no pain. In 3 weeks, he will start strengthening therapy, start his full duty at work and get back to his favorite gym.