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Distal Radioulnar Joint Dislocation
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Contents
Other Names
- DRUJ Injury
- Distal Radioulnar Joint Disruption
- Distal Radioulnar Joint Instability
- Distal Radioulnar Joint Subluxation
- DRUJ Disruption
- DRUJ Instability
- DRUJ Subluxation
Background
- Reflects interruption of the Distal Radial Ulnar Joint
- Stability maintained by Radius, Ulna, Triangular Fibrocartilage Complex, Pronator Quadratus and Interosseous Membrane of Forearm
- Commonly missed diagnosis
- Rare in isolation, more commonly associated with wrist and forearm fracture-dislocations
Pathophysiology
- Dorsal dislocation more common than volar
- 10-19% associated with distal radius fractures[1]
- Commonly associated injuries
Risk Factors
- Unknown
Differential Diagnosis
Differential Diagnosis Wrist Pain
- Fractures
- Dislocations
- Instability & Degenerative
- Tendinopathies & Ligaments
- Neuropathies
- Pediatric Considerations
- Distal Radial Epiphysitis (Gymnast's Wrist)
- Torus Fracture
- Arthropathies
- Cartilage
- Vascular
- Other
Differential Diagnosis Forearm Pain
- Fractures
- Pediatric Specific Fractures
- Dislocations & Instability
- Soft Tissue Trauma
- Tendinopathies
- Neuropathies
- Pediatric Considerations
Clinical Features
- History
- Needs to be updated
- Physical Exam: Physical Exam Wrist
- Acute
- Patient has swelling, deformity
- Inability to supinate/pronate the forearm
- Subacute/ Chronic
- Snapping, crepitus
- Decreased grup strength
- Acute
- Special Tests
- DRUJ Compression Test: Exacerbating symptoms with compression
- Piano Key Test: Pain with manipulation of distal ulna
Evaluation
Radiographs
- Standard Radiographs Wrist
- Typically sufficient to make diagnosis
- AP view: widening of DRUJ
- Lateral view: dorsal displacement (most commonly)
- Description of ulnar in reference to the radius
CT
- Can be performed dynamically for subtle DRUJ injuries
MRI
- Evaluate for other soft tissue injuries
Classification
- NA
Management
Nonoperative
- Nonsurgical management indicated in some cases
- Consider in less active patients
- Functional brace
- Physical Therapy
- Indications
- Isolated ligamentous injury without fracture
- TFCC Tear (acute)
- Closed reduction
- Cast: Short Arm Cast for 4-6 weeks
Operative
- Indications:
- Ulnar styloid fracture displaced with instability
- Essex-Lopresti Fracture
- Galeazzi Fracture
Return to Play
- Highly variable depending on injury pattern
- In general, minimum 6 weeks and will require post-recovery rehab
Complications
- DRUJ Arthritis
See Also
- Internal
- External
- Sports Medicine Review Wrist Pain: https://www.sportsmedreview.com/by-joint/wrist/
References
- ↑ Mirghasemi AR, Lee DJ, Rahimi N, Rashidinia S, Elfar JC. Distal Radioulnar Joint Instability. Geriatr Orthop Surg Rehabil. 2015 Sep;6(3):225-9.
Created by:
John Kiel on 18 June 2019 23:03:09
Authors:
Last edited:
13 October 2022 21:47:45
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