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The distal radioulnar articulation [1] (also known as the distal radioulnar joint, [2] or inferior radioulnar joint [1] [3]) is a synovial pivot joint between the two bones in the forearm; the radius and ulna. It is one of two joints between the radius and ulna, the other being the proximal radioulnar articulation.
An alternative treatment for patients with ulnar-sided wristpain is a total replacement of the distal radial-ulnar joint. There are many surgical treatments of the condition, but most of these only improve the alignment and function of the radiocarpal joint. A persistent problem in these treatments has been the stiff DRUJ.
Total wrist arthrodesis is the standard surgical treatment for patients with stage IV wrist osteoarthritis. During this procedure the carpal bones are all fused together and are then fastened to the distal radius. [14] This procedure eliminates all wrist motion, but heavy labor is still possible. [19]
The Apley scratch test specifically tests range of motion and in a normal exam, an individual should be able to reach C7 on external rotation, and T7 on internal rotation. Evaluation of distal pulses; Strength testing: wrist extension tests the radial nerve, finger abduction tests the ulnar nerve, and thumb apposition tests the median nerve.
DRUJ stress test: With this provocation maneuver, the wrist is held in pronated or supinated position, while the physician attempts to manipulate the distal ulna in dorsal and volar direction. Painful laxity indicates DRUJ instability and suggests RUL pathology. [2] Ulnar grind test: The forearm is fixated and the wrist is held in dorsiflexion.
The major exception is when the joint between these bones, the distal radioulnar joint (or DRUJ), is unstable. When the DRUJ is unstable, the ulnar styloid may require independent treatment. An excessively long styloid process of the ulna can cause painful contact with the triquetral bone in the wrist, known as ulnar styloid impaction syndrome. [1]
Persistent pain in the wrist after conservative treatment is the major indication for a diagnostic wrist arthroscopy. Conservative treatment consists of wrist immobilization, oral NSAIDs and/or injection with corticoids. [11] Diagnostic wrist arthroscopy may also be indicated when other imaging techniques, such as MRI and ultrasonography, need
Joints of the hand, X-ray. The bones in each carpal row interlock with each other and each row can therefore be considered a single joint. In the proximal row a limited degree of mobility is possible, but the bones of the distal row are connected to each other and to the metacarpal bones by strong ligaments that make this row and the metacarpus a functional entity.