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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