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Distal radioulnar joint problems Discussion
The distal radioulnar joint may give rise to symptoms of pain, instability,
arthritis and other problems. This joint is responsible for rotation of the
forearm (palm-up, palm-down). Problems either from injury, such as a wrist
fracture, or from degenerative arthritis are common at this site.
Inflammation of this joint often extends to involve the adjacent extensor
tendons, resulting in extensor tenosynovitis. The effects of injury or
inflammation often affect the relative positions of the radius and ulna, so
that the distal ulna becomes more prominent on the dorsum of the wrist.
This creates additional extensor tendon irritation and may lead to
weakening or tendon rupture. Distal radioulnar joint disorders have been
classified by Bowers as follows:
I. Acute Fracture
II. Acute Joint Injury
III. Chronic or Late-appearing joint disruption
IV. Chronic Joint Disorder
V. Extensor Carpi Ulnaris Tendon Snapping
VI. Fixed Rotational Deformity
Treatment is individualized, and is determined by this type of
classification as well as other patient factors. Conservative management
consists measures such as splinting, therapy, antiinflammatory medication
and local cortisone injection. Conservative treatment has the risk of
extensor tendon rupture, and for this reason surgery is indicated for
persistent tendinitis, as well as for intractable pain. Forearm rotation
may be improved after surgery, but this is quite unpredictable. Surgery may
involve exploration of the joint, removal of the distal end of the ulna,
ulnar shortening, soft tissue joint stabilization, or other procedures.
Problems after this type of surgery include a feeling of instability or
clunking with motion, which can be troublesome and for which there is no
good cure. Another potential problem is weakness and numbness, and there
will be a visible scar. Pain relief is unpredictable. Range of motion may
or may not improve postoperatively. If an extensor tendon rupture occurs
from untreated problems, there is a risk of additional extensor tendon
rupture.
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