Distal Radioulnar Joint Arthritis
synonyms:Distal Radioulnar Joint arthritis, DRUJ arthritis, DRUJ pain
DRUJ Arthritis ICD-9
DRUJ Arthritis Etiology / Epidemiology / Natural History
- Etiology: overuse, fracture, ligament injury, DRUJ instability, inflammatory arthritis.
DRUJ Arthritis Anatomy
- DRUJ static restraints = sigmoid notch of the distal radius, dorsal and palmar radioulnar ligaments, the interosseous membrance and the dorsal retinaculum.
- DRUJ dynamic restaints = pronator quadratus, extensor carpi ulnaris and the flexor carpi ulnaris.
- Extensor carpi ulnaris with the attached TFCC and styloid fragment may prevent closed reduction. After the ECU has been detached from the distal part of the ulna together with the TFCC and the ulnar styloid process, it slips around either the radial or ulnar boarder of the distal part of the ulna to lie volar to it, Consequently, the joint cannot be reduced until the tendon with the attached TFCC and styloid fragment has been returned to it’s anatomical position. (Hanel DP, CORR 1988;234:56).
- Sigmoid notch of radius has a radius of curvature of 15mm. Ulnar head has a radius of curvature of 10mm.
- The ulnar head translates 5.4mm volarly in supination and 2.8mm dorsally in pronation. (Pirela-Cruz MA, J Hand Surg [Am]. 1991;16:75).
- Dorsal radioulnar ligaments are tight in pronation; lax is supination. Dorsal capsule imbrication prevents volar translation of the radius.
- Palmar radioulnar ligaments are tight in supination and lax in pronation. Palmar capsu
DRUJ Arthritis Clinical Evaluation
DRUJ Arthritis Xray / Diagnositc Tests
- P/A, lateral and oblique views of both wrists. Evaluate for arthritic changes (joint space narrowing, sclerosis, osteophytosis). Subluxation or dislocation can be seen on a true lateral xray with the arm in neutral rotation. Consider lateral views of both wrists taken with the forearm in pronation. Measure ulnar variance.
- Signs of DRUJ injury: fracture at the base of the ulnar styloid, widening of the DRUJ space seen on the P/A xray, >20° of dorsal radial angulation, and >5 mm of proximal displacement of the distal part of the radius. (Szabo RM, JBJS 2006;88A:884).
- CT indicated if diagnosis is in question or pain / deformity limits the ability to obtain true lateral xray. (Mino DE, JBJS 1985;67A:247)
- MRI: useful to evaluate for TFCC injury and to assess DRUJ subluxation. DRUJ subluxation can be quanified using the radiolulnar ratio (Lo IK, J Hand Surg 2001;26A:236).
DRUJ Arthritis Classification / Treatment
- Conservative Treatment: NSAIDs, long arm/Munster splint that restricts supination/pronation, steriod injections
- Ulnocarpal impaction
Treatment =ulnar shortening.
- Symptomatic DRUJ arthritis which has failed conservative treatment
Treatment options = distal ulnar resection (Darrach), paritial ulnar resection and interporition (Bowers or Watson), radioulnar arthrodesis with proximal ulna segment resection (Sauve-Kapandji), ulnar head replacement (Berger RA, Hand Clin 2005;21:603).
DRUJ Arthritis Associated Injuries / Differential Diagnosis
DRUJ Arthritis Complications
- Joint weakness
- Ulnar drift of the carpus
- Ulnar stump instability
- Decrease grip strength
DRUJ Arthritis Follow-up Care
DRUJ Arthritis Review References