Distal radioulnar joint dislocation is more commonly displaced dorsally (i.e. the distal ulna is dorsally dislocated with respect to the distal radius) but can be vulgarly displaced. If more than 50% of the articular surfaces do not articulate, then the term DRUJ subluxation is used. Distal Radioulnar Joint Instability occurs when articular contact between the two forearm bones at the wrist follows an abnormal path in rotation. Though this is an exceptionally stable and mobile joint, it is prone to injury when someone falls on an outstretched hand (FOOSH) with the wrist pronated.
Other Names
- DRUJ Injury
- Distal Radioulnar Joint Disruption
- Distal Radioulnar Joint Instability
- Distal Radioulnar Joint Subluxation
- DRUJ Disruption
- DRUJ Instability
- DRUJ Subluxation
Pathophysiology
- 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
- Dorsal dislocation is more common than volar
- 10-19% are associated with distal radius fractures[1]
- Commonly associated injuries
- Distal Radius Fracture
- Galeazzi Fracture
- Essex Lopresti Fracture
- TFCC Injury
- Distal Ulna Fracture
Differential Diagnosis
Differential Diagnosis Wrist Pain
- Fractures
- Distal Radius Fracture
- Barton’s Fracture
- Chauffer’s Fracture
- Colles’ Fracture
- Die-Punch Fracture
- Radial Styloid Fracture
- Smith’s Fracture
- Distal Ulna Fracture
- Carpal Fractures
- Scaphoid Fracture
- Lunate Fracture
- Triquetrum Fracture
- Pisiform Fracture
- Trapezium Fracture
- Trapezoid Fracture
- Capitate Fracture
- Hamate Fracture
- Essex Lopresti Fracture
- Distal Radius Fracture
- Dislocations
- Carpometacarpal Joint Dislocation
- Distal Radioulnar Joint Dislocation
- Lunate Dislocation
- Perilunate Dislocation
- Instability & Degenerative
- Scapholunate Instability
- Lunotriquetral Instability
- Scaphoid Nonunion Advanced Collapse
- Distal Radial Ulnar Joint Instability
- Kienbocks Disease
- Tendinopathies & Ligaments
- De Quervain’s Tenosynovitis
- Intersection Syndrome
- TFCC Injury
- Wrist Tendinopathies
- Extensor Carpi Ulnaris Instability
- Neuropathies
- Carpal Tunnel Syndrome
- Pronator Teres Syndrome
- Anterior Interosseus Nerve Syndrome
- Posterior Interosseus Nerve Syndrome
- Guyon Canal Syndrome
- Pediatric Considerations
- Distal Radial Epiphysitis (Gymnast’s Wrist)
- Torus Fracture
- Arthropathies
- Wrist Osteoarthritis
- Rheumatoid Arthritis
- Cartilage
- Osteochondral Defect
- Vascular
- Hypothenar Hammer Syndrome
- Other
- Ganglion Cyst of Wrist
- Ulnar Impingement Syndrome
- Infectious Tenosynovitis
Differential Diagnosis Forearm Pain
- Fractures
- Distal Radius Fracture
- Barton’s fracture
- Chauffer’s Fracture
- Colles’ Fracture
- Die-Punch Fracture
- Radial Styloid Fracture
- Smith’s Fracture
- Radius Ulna Fracture (Both Bone)
- Proximal Radius Fracture (Head, Neck)
- Isolated Ulna Fracture
- Monteggia Fracture
- Galeazzi Fracture
- Distal Ulna Fracture
- Essex Lopresti Fracture
- Distal Radius Fracture
- Pediatric Specific Fractures
- Torus Fracture
- Greenstick Fracture
- Salter-Harris Fracture
- Plastic Deformation
- Dislocations & Instability
- Distal Radioulnar Joint Dislocation
- Proximal Radioulnar Joint Instability
- Soft Tissue Trauma
- Acute Compartment Syndrome
- Tendinopathies
- De Quervain’s Tenosynovitis
- Intersection Syndrome
- Neuropathies
- Radial Tunnel Syndrome
- Posterior Interosseus Nerve Syndrome
- Pediatric Considerations
- Distal Radial Epiphysitis
Diagnosis
- 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
Radiographs
- Standard Radiographs Wrist
- Typically sufficient to make a 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
Treatment
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
