Disclosures: Brian Malave, BA: No financial relationships or conflicts of interest

Case Diagnosis: Flexor carpi ulnaris (FCU) tendinopathy

Case Description: A 55-year-old female librarian presented with pain along the volar aspect of the right ulna of many months duration. A librarian, she attributed this to change in her work during the COVID-19 pandemic, where she was suddenly extensively shelving and picking up books. Radiographs were normal. She was diagnosed with FCU tendinopathy and treated successfully with eccentric exercises and a saline anesthetic injection.

Setting: Outpatient clinic (Middlebury, VT)

Assessment/Results: Eccentric exercises and normal saline injection completely resolved the patient’s symptoms at 1-month follow-up

Discussion: FCU tendinopathy is rarely reported in the literature, with only 8 case reports presenting a total of 12 total cases dating back to 1951. Of these, there has been only 1 other case report of occupationally-related FCU tendinopathy, and 1 other case report of FCU tendinopathy despite normal radiographs. Furthermore, to our knowledge our study is the first to report the use of normal saline injection – which has been used for treatment of patellar and Achilles’ tendinopathies – for successful treatment of FCU tendinopathy.

Conclusion: FCU tendinopathy is an overlooked diagnosis that may be common in patients who use their forearm flexor muscles repeatedly. While most cases of FCU tendinopathy reported in the literature have calcification on x-rays, we suspect many cases do not have calcification since tendinopathies are not always calcific in nature. The standard for diagnosis of FCU tendinopathy should be the physical exam, much like it is for lateral epicondylitis. Lastly, our study suggests that normal saline injections merit consideration as an alternative to corticosteroid injections for treatment of FCU tendinopathies.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/bookshelvers-tendinopathy-in-the-time-of-covid-flexor-carpi-ulnaris-tendinopathy-in-a-librarian/