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Muscle deep-dives

Extensor Carpi Radialis Longus trigger points: referred pain, palpation and release

A clinical deep-dive on Extensor Carpi Radialis Longus: trigger point locations, the referred pain pattern they produce, palpation landmarks, activating factors and an evidence-based release protocol.

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Extensor Carpi Radialis Longus trigger points: referred pain, palpation and release
Wrist extensors (extensor carpi radialis longus/brevis and extensor carpi ulnaris) — trigger points and referred pain to the lateral elbow, dorsum of the hand and wrist.

Why this muscle causes pain

Extends and radially deviates the wrist. Trigger points here are common in everyday and athletic populations and frequently contribute to the referred pain patterns described below.

Where the trigger points sit

Dorsal lateral forearm just distal to the lateral epicondyle.

The referred pain pattern

Lateral elbow and the dorsum of the hand — classic 'tennis elbow' presentation.

How to find it by palpation

Palpate the muscle belly along its accessible course. Reproduction of the patient's familiar pain on palpation supports involvement.

What sets it off

Mouse use, racquet sports, repeated gripping.

Self-care that actually helps

Eccentric wrist extension, grip strengthening. Clinically: needling, address grip ergonomics.

Symptoms this muscle produces

Clinically, this muscle turns up in the workup of dorsal forearm pain, dorsal wrist & hand pain, elbow pain, lateral epicondylar pain and thumb & radial hand pain. Those are the complaints its referral zone overlaps, which is why a patient may present with any of them and never mention the muscle itself.

Studies cited

Every claim in this article traces back to one of the sources below.

  1. Kietrys 2013Effectiveness of dry needling for upper-quarter myofascial pain: a systematic review and meta-analysis. J Orthop Sports Phys Ther 2013;43(9):620-34
  2. Gattie 2017The effectiveness of trigger point dry needling for musculoskeletal conditions by physical therapists: a systematic review and meta-analysis. J Orthop Sports Phys Ther 2017;47(3):133-49
  3. Boyles 2015Effectiveness of trigger point dry needling for multiple body regions: a systematic review. J Man Manip Ther 2015;23(5):276-93
  4. Charles 2019A systematic review of manual therapy techniques, dry cupping and dry needling in the reduction of myofascial pain and myofascial trigger points. J Bodyw Mov Ther 2019;23(3):539-46
  5. Cagnie 2013Physiologic effects of dry needling. Curr Pain Headache Rep 2013;17(8):348
  6. Fernández-de-las-Peñas 2019Trigger point dry needling for the treatment of myofascial pain syndrome: current perspectives within a pain neuroscience paradigm. J Pain Res 2019;12:1899-911
  7. Shah 2015Myofascial trigger points then and now: a historical and scientific perspective. PM R 2015;7(7):746-61
  8. Halle 2016Pertinent dry needling considerations for minimizing adverse effects. Int J Sports Phys Ther 2016;11(5):651-62
  9. Boyce 2020Adverse events associated with therapeutic dry needling. Int J Sports Phys Ther 2020;15(1):103-13
  10. Hong 1994Lidocaine injection versus dry needling to myofascial trigger point: the importance of the local twitch response. Am J Phys Med Rehabil 1994;73(4):256-63
  11. Simons & TravellMyofascial Pain and Dysfunction: The Trigger Point Manual (2nd ed.). Williams & Wilkins, Baltimore

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