Distal Radioulnar Joint Dislocation

Last updated: February 8, 2026Reviewed date: February 8, 2026Reading time: 3 min read
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Article Summary

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....

Key Takeaways

  • This article explains Other Names in simple medical language.
  • This article explains Pathophysiology in simple medical language.
  • This article explains Differential Diagnosis in simple medical language.
  • This article explains Diagnosis in simple medical language.
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Definition

Distal radioulnar is more commonly displaced dorsally (i.e. the distal is dorsally dislocated with respect to the distal ) 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
  • Rare in isolation, more commonly associated with wrist and forearm -dislocations
  • Dorsal 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 Wrist

  • 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
  • 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 &
    • De Quervain’s Tenosynovitis
    • Intersection
    • TFCC Injury
    • Wrist Tendinopathies
    • Extensor Carpi Ulnaris Instability
  • Neuropathies
    • 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
    • Osteochondral Defect
  • Vascular
    • Hypothenar Hammer Syndrome
  • Other
    • 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
  • Pediatric Specific Fractures
    • Torus Fracture
    • Greenstick Fracture
    • Salter-Harris Fracture
    • Plastic Deformation
  • Dislocations & Instability
    • Distal Radioulnar Joint Dislocation
    • Proximal Radioulnar Joint Instability
  • Soft Tissue
  • 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 , deformity
      • Inability to supinate/pronate the forearm
    • /
      • Snapping, crepitus
      • Decreased grup strength
  • 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

  • Can be performed dynamically for subtle DRUJ injuries

  • Evaluate for other soft tissue injuries

Treatment

Nonoperative

  • Nonsurgical management indicated in some cases
    • Consider in less active patients
    • Functional brace
  • 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
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A simple rural-patient checklist to help you explain symptoms clearly, ask better questions, and avoid unsafe self-treatment.

Safety note: This is not a prescription or diagnosis. For severe symptoms, pregnancy danger signs, children with serious illness, chest pain, breathing difficulty, stroke-like weakness, or major injury, seek urgent care.

Which doctor may help?

Start with a registered doctor or the nearest qualified health center.

What to tell the doctor

  • Write when the problem started and how it changed.
  • Bring old prescriptions, investigation reports, and current medicines.
  • Write allergies, pregnancy status, diabetes, kidney/liver disease, and major past illnesses.
  • Bring one family member if the patient is weak, elderly, confused, or a child.

Questions to ask

  • What is the most likely cause of my symptoms?
  • Which danger signs mean I should go to hospital quickly?
  • Which tests are necessary now, and which can wait?
  • How should I take medicines safely and what side effects should I watch for?
  • When should I come for follow-up?

Tests to discuss

  • Vital signs: temperature, pulse, blood pressure, oxygen saturation
  • Basic physical examination by a clinician
  • CBC, urine test, blood sugar, or imaging only when clinically needed

Avoid these mistakes

  • Do not use antibiotics, steroid tablets/injections, or strong painkillers without proper medical advice.
  • Do not hide pregnancy, kidney disease, ulcer, allergy, or blood thinner use.
  • Do not delay emergency care when danger signs are present.

Medicine safety and first-aid guide

This section is for patient education only. It does not replace a doctor, pharmacist, or emergency care.

Safe first steps

  • Rest, drink safe water, and observe symptoms carefully.
  • Keep a written note of symptoms, duration, temperature, medicines already taken, and allergy history.
  • Seek medical care quickly if symptoms are severe, worsening, or unusual for the patient.

OTC medicine safety

  • For mild pain or fever, ask a registered pharmacist or doctor before using common over-the-counter pain/fever medicines.
  • Do not combine multiple pain medicines without advice, especially if you have kidney disease, liver disease, stomach ulcer, asthma, pregnancy, or take blood thinners.
  • Do not give adult medicines to children unless a qualified clinician advises it.

Avoid these mistakes

  • Do not start antibiotics without a proper medical decision.
  • Do not use steroid tablets or injections casually for quick relief.
  • Do not delay emergency care because of home remedies.

Get urgent help if

  • Severe symptoms, confusion, fainting, breathing difficulty, chest pain, severe dehydration, or sudden weakness need urgent medical care.
Medicine names, dose, and timing must be decided by a qualified clinician or pharmacist after checking age, pregnancy, allergy, other diseases, and current medicines.

For rural patients and family caregivers

Patient health record and symptom diary

Write your symptoms, medicines already taken, test results, and questions before visiting a doctor. This note stays on your device unless you print or copy it.

Doctor to discuss: Doctor / qualified healthcare provider
Tests to discuss with doctor
  • Basic vital signs: temperature, pulse, blood pressure, oxygen level if needed
  • Relevant blood, urine, imaging, or specialist tests only after clinical assessment
Questions to ask
  • What is the most likely cause of my symptoms?
  • Which warning signs mean I should go to emergency care?
  • Which tests are really needed now?
  • Which medicines are safe for my age, pregnancy status, allergy, kidney/liver/stomach condition, and current medicines?

Emergency warning signs such as chest pain, severe breathing difficulty, sudden weakness, confusion, severe dehydration, major injury, or loss of bladder/bowel control need urgent medical care. Do not wait for online information.

Safe pathway to proper treatment

Care roadmap for: Distal Radioulnar Joint Dislocation

Use this simple roadmap to understand the next safe steps. It is educational and does not replace examination by a doctor.

Go to emergency care if you notice:
  • Severe or rapidly worsening symptoms
  • Breathing difficulty, chest pain, fainting, confusion, severe weakness, major injury, or severe dehydration
Doctor / service to discuss: Qualified healthcare provider; specialist depends on symptoms and examination.
  1. Step 1

    Check danger signs first

    If danger signs are present, seek emergency care and do not wait for online information.

  2. Step 2

    Record the symptom story

    Write when symptoms started, severity, medicines already taken, allergies, pregnancy status, and test results.

  3. Step 3

    Visit a qualified clinician

    A doctor, nurse, or qualified healthcare provider can examine you and decide which tests or treatment are needed.

  4. Step 4

    Do only useful tests

    Do tests after clinical assessment. Avoid unnecessary tests, random antibiotics, or repeated medicines without diagnosis.

  5. Step 5

    Follow up and return early if worse

    If symptoms worsen, new warning signs appear, or treatment is not helping, return for review quickly.

Rural patient practical tips
  • Take a written symptom diary and all previous prescriptions/test reports.
  • Do not hide medicines already taken, even herbal or over-the-counter medicines.
  • Ask which warning signs mean urgent referral to hospital.

This roadmap is for education. A real diagnosis and treatment plan requires history, examination, and clinical judgment.