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Flexor Carpi Ulnaris (FCU) Tenderness

Exams and Signs

Description

  • Flexor carpi ulnaris (FCU) tenderness occurs approximately 3 cm proximal to the FCU tendon’s insertion on the pisiform.1
  • FCU tendinopathy is similar to pathologies of the pisotriquetral (PT) joint.1

Pathophysiology

  • FCU tenderness may be caused by a flexor tendon injury, a triangular fibrocartilage complex (TFCC) tear, PT arthritis or posttraumatic arthritis. Tendon injuries often result from excessive mechanical overload.1
  • FCU tenderness may also be caused by acute calcific tendinitis, at the insertion of the FCU tendon at the pisiform. Acute calcific tendinitis is often misdiagnosed as an infection.2
  • In rare cases, ulnar instability of the carpus may lead to FCU tenderness.

Instructions

  1. Record the patient’s history, including any sports-related injuries. Ask the patient to rate how much pain s/he usually experiences in the affected wrist on a scale from 1 to 10.
  2. Palpate the FCU tendon along its course to observe any focal tenderness.3
  3. Check for crepitus, swelling and/or pain of the FCU.
  4. Examine the contralateral wrist for comparison.

Variations

  • Another symptom to consider is a clunking sensation of the ulnar wrist on palpation. This may indicate ulnar instability of the carpus.4

Related Signs and Tests

  • PT tenderness
  • TFCC tenderness
  • Neurovascular exam
  • Radiography
  • Arthroscopy4

Diagnostic Performance Characteristics

  • After examining the wrist, radiography and arthroscopy may be useful to improve reliability. Radiography can effectively diagnose acute calcific tendinitis.2
  • Do not use other patients’ reactions as a comparison, because other patients may have different perceptions of similar tenderness and/or pain.
Presentation Photos and Related Diagrams
Flexor Carpi Ulnaris Examination
  • Examination for FCU tenderness
    Examination for FCU tenderness
Definition of Positive Result
  • A positive result occurs when there is increased tenderness in the FCU with pressure.
Definition of Negative Result
  • A negative result occurs when pressure does not cause increased tenderness in the FCU. 
Comments and Pearls
  • In treating FCU injuries, if non-operative options do not succeed, FCU tendon debridement may relieve pain.1
Diagnoses Associated with Exams and Signs
References
  1. Budoff JE, Kraushaar BS, Ayala G. Flexor Carpi Ulnaris Tendinopathy. J Hand Surg Am 2005;30A:125-9. PMID: 15680567
  2. Torbati SS, Bral D, Geiderman JM. Acute calcific tendinitis of the wrist. J Emerg Med 2013;44(2):352-4. PMID: 23116933
  3. Culp R, Jacoby S. Musculoskeletal Examination of the Elbow, Wrist and Hand: Making the Complex Simple. New Jersey: SLACK Incorporated, 2012.
  4. Pillukat T, Van Schoonhoven J, Lanz U. Ulnar instability of the carpus. (Article in German) Orthopade. 2004;33(6):676-84. PMID: 15127197
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