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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 injury can be difficult to diagnose initially as medical attention is usually focused on the injury to the radial head, leading to the distal radio-ulnar injury being overlooked. The examination finding of tenderness of the distal radio-ulnar joint suggests an Essex-Lopresti injury in patients who have sustained high energy forearm trauma.
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.
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]
A plate is attached to the distal end of the ulna, to plan the osteotomy. An oblique segment is removed from the ulna, after which the distal radial-ulnar joint is freed, making sure structures stay attached to the styloid process. After this, the freed distal end is reattached to the proximal ulna with the formerly mentioned plate. [6]
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.
The articular surface for the ulna is called the ulnar notch (sigmoid cavity) of the radius; it is in the distal radius, and is narrow, concave, smooth, and articulates with the head of the ulna forming the distal radioulnar joint.
The radial collateral ligament (external lateral ligament, radial carpal collateral ligament) extends from the tip of the styloid process of the radius and attaches to the radial side of the scaphoid (formerly navicular bone of the hand), immediately adjacent to its proximal articular surface and some fibres extend to the lateral side of the trapezium (greater multangular bone).