RESEARCH ARTICLE


Clinical and Non-Clinical Aspects of Distal Radioulnar Joint Instability



MME Wijffels*, 1, PRG Brink2, IB Schipper1
1 Leiden University Medical Center, Department of Surgery-Traumatology, P.O. Box 9600, 2300 RC Leiden, The Netherlands
2 Maastricht University Medical Center, Dept. of Surgery and Traumatology, P.O. Box 616, 6200 MD Maastricht, The Netherlands


© Wijffels et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited..

* Address correspondence to this author at the Leiden University Medical Center, Department of Surgery-Traumatology, Address: P.O. Box 9600, 2300 RC Leiden, the Netherlands; Tel: +31.71.526.9111; Fax: +31.71.526.6750; E-mail: M.M.E.Wijffels@lumc.nl


Abstract

Untreated distal radioulnar joint (DRUJ) injuries can give rise to long lasting complaints. Although common, diagnosis and treatment of DRUJ injuries remains a challenge. The articulating anatomy of the distal radius and ulna, among others, enables an extensive range of forearm pronosupination movements. Stabilization of this joint is provided by both intrinsic and extrinsic stabilizers and the joint capsule. These structures transmit the load and prevent the DRUJ from luxation during movement. Several clinical tests have been suggested to determine static or dynamic DRUJ stability, but their predictive value is unclear. Radiologic evaluation of DRUJ instability begins with conventional radiographs in anterioposterior and true lateral view. If not conclusive, CT-scan seems to be the best additional modality to evaluate the osseous structures. MRI has proven to be more sensitive and specific for TFCC tears, potentially causing DRUJ instability. DRUJ instability may remain asymptomatic. Symptomatic DRUJ injuries treatment can be conservative or operative. Operative treatment should consist of restoration of osseous and ligamenteous anatomy. If not successful, salvage procedures can be performed to regain stability.

Keywords: Distal radioulnar joint, DRU-joint, instability, wrist.